全脊椎切除术与分离术治疗胸腰椎孤立性转移肿瘤的疗效比较

Effect comparison between total en-bloc spondylectomy and separate surgery in the treatment of thoracolumbar isolated metastatic tumor

目的比较全脊椎切除术与分离术治疗胸腰椎孤立性转移肿瘤的临床疗效。方法回顾性分析自2012-07-2017-08诊治的55例胸腰椎孤立性转移瘤,29例采用全脊椎切除术治疗(切除组),26例采用分离手术治疗(分离组),比较2组手术时间、术中出血量、并发症情况、复发胸腰椎转移瘤数、术后生存时间以及末次随访时疼痛VAS评分、Frankel神经功能等级。结果2组均顺利完成手术并获得完整随访,随访时间5~37个月,平均22.5个月。分离组手术时间较切除组少,差异有统计学意义(P<0.05)。2组术中出血量比较差异无统计学意义(P>0.05)。切除组术后并发症、复发胸腰椎转移瘤数较分离组少,生存时间较分离组长,差异有统计学意义(P<0.05)。末次随访时2组疼痛VAS评分、Frankel神经功能等级比较差异无统计学意义(P>0.05)。结论全脊椎切除术与分离术治疗胸腰椎孤立性转移肿瘤可改善患者疼痛、神经功能症状,全脊椎切除术在减少局部复发胸腰椎转移瘤、提高患者生存时间方面具有一定优势。

Objective To compare the clinical efficacy between total en-bloc spondylectomy and separate surgery in the treatment of thoracolumbar isolated metastatic tumors.Methods Fifty-five cases of thoracolumbar isolated metastatic tumors from July 2012 to August 2017 were retrospectively analyzed.29 cases were treated by total en-bloc spondylectomy(excision group),and 26 cases were treated by separate surgery(separation group).The time of operation,bleeding,complications,tumor recurrence,survival time as well as pain VAS score and Frankel neurological function grade at the final follow-up were compared between the two groups.Results Both groups were followed up successfully for 5 to 37 months(average 22.5 months).The operation time of the separation group was less than that of the excision group,the difference between the two groups was statistically significant(P<0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).The excision group has less complications,recurrence and longer survival time(P<0.05).At the last follow-up,there was no significant difference between the two groups in pain VAS score and F rankel neurological function grade(P>0.05).Conclusion Both total en-bloc spondylectomy and separate surgery for thoracolumbar isolated metastatic tumors could improve pain and neurological symptoms.Total en-bloc spondylectomy has certain advantages of reducing local recurrent thoracic and lumbar metastases and improving the survival time of patients.