分离手术+椎体成形术+^(125)I粒子植入治疗肺腺癌脊柱转移并脊髓受压初步研究

Preliminary research of separation surgery+vertebroplasty+^(125)I particle implantation in the treatment of lung adenocarcinoma patients with spinal metastasis and spinal cord compression

目的探讨分离手术联合椎体成形术+^(125)I粒子植入术(SSVPI)治疗肺腺癌脊柱转移并脊髓受压患者的临床疗效及并发症。方法回顾性分析2017—2019年间在我院诊治的22例肺腺癌脊柱转移并脊髓受压患者临床资料。所有患者均实施经后路SSVPI术,术后常规化疗及靶向治疗。采用Frankel分级、ECOG分级和VAS评分评价患者手术前后在脊髓功能、体力功能和疼痛评分变化情况,并观察并发症。结果胸椎平均植入^(125)I粒子25.3颗,腰椎平均植入^(125)I粒子33.2颗,病椎骨水泥平均注射3.62 ml。术前22例患者均存在不同程度的脊髓功能损害症状,术后16例患者脊髓功能明显改善(P<0.05)。22例患者术后第1、3、6个月的VAS评分和ECOG分级均低于术前(P<0.05);22例患者中除了5例患者术中出现骨水泥渗漏和1例患者术后出现脑脊液漏外,均未出现气胸、肺栓塞、放射性脊髓炎和二次脊髓受压等严重并发症。结论采用SSVPI术治疗肺腺癌脊柱转移并脊髓受压患者不仅能够改善脊髓功能状态、重建脊柱稳定和缓解疼痛,同时可以通过组织间^(125)I粒子植入近距离治疗增加局部抗肿瘤效果,是一种有前景的治疗邻近多节段脊柱转移患者的手术方案。

Objective To investigate the clinical efficacy and complications of separation surgery+vertebroplasty+^(125)I seed particle implantation(SSVPI)in the treatment of lung adenocarcinoma patients with spinal metastasis and spinal cord compression.Methods The clinical data of 22 lung adenocarcinoma patients with spinal metastasis and spinal cord compression diagnosed and treated in our hospital from January 2017 to January 2019 were retrospectively analyzed.All patients underwent the surgical procedure of SSVPI,conventional chemotherapy and targeted therapy after surgery.Frankel grading,ECOG grading and VAS score were used to evaluate the changes of spinal cord function,physical function,and pain score before and after surgery.Meanwhile the complications were observed.Results All patients received an average of 25.3^(125)I seeds implanted in the thoracic vertebra,33.2^(125)I seeds implanted in the lumbar vertebra,and an average of 3.62 ml bone cement injected in diseased vertebral.All patients presented varying degrees of spinal cord function impairment symptoms before surgery,and 16 patients showed significant improvement in spinal cord function after surgery(P<0.05).The VAS scores and ECOG grades of 22 patients in the third and sixth months after surgery were significantly lower than those before surgery(P<0.05).Among the 22 patients,pneumothorax,pulmonary embolism,secondary spinal cord injury,secondary spinal cord compression and other serious complications were not found except for 5 cases of intraoperative cement leakage and 1 case of postoperative cerebrospinal fluid leakage.Conclusions SSVPI in the treatment of lung adenocarcinoma patients with spinal metastases and spinal cord compression can not only improve the spinal cord function state,reconstruct the spinal stability and relieve pain,but also can increase local anti-tumor effect through^(125)I seeds implantation brachytherapy,which will be a promising surgery used to treat the adjacent multiple segments spine metastatic patients.