摘要
目的：比较全脊椎碎块切除、全脊椎大块切除和全脊椎整块切除3种方法治疗腰椎转移瘤的临床效果。方法：回顾性分析2008年1月至2013年10月收治的20例腰椎转移瘤患者的临床资料,其中男8例,女12例;年龄35-65岁,平均（49.50±9.97）岁;均为单节段孤立转移。肿瘤部位：L14例,L25例,L34例,L44例,L53例。Tomita分型：Ⅱ型4例,Ⅲ型6例,Ⅳ型6例,Ⅴ型4例。Tokuhashi评分12.50±1.97,所有患者有腰背部或下肢疼痛症状,疼痛视觉评分（VAS）为8.13±0.85。分别采用全脊椎碎块切除（A组7例）、全脊椎大块切除（B组7例）和全脊椎整块切除（C组6例）进行治疗。通过观察手术时间、术中出血量和术中输血量等评价手术的创伤性;比较术前与术后1周的VAS评分评价临床症状改善情况;观察手术前后正侧位X线片评价手术实施情况;比较3组患者术后肿瘤的复发和死亡情况评价手术的后期效果。结果：20例患者均获随访,时间6-36个月,平均（16.50±7.88）个月。手术时间、术中出血量、术中输血量A组分别为（6.14±0.68）h,（3 457.14±399.40）ml,（2 771.43±423.14）ml;B组分别为（4.93±0.61）h,（1 942.86±378.51）ml,（1 500.00±336.65）ml;C组分别为（4.17±0.67）h,（1341.67±361.13）ml,（916.67±321.66）ml,3组比较差异有统计学意义（P〈0.05）,整块切除术优于大块切除术,大块切除术优于碎块切除术。3种手术方式术后1周VAS评分较术前均有明显下降（P〈0.05）,3组间比较差异无统计学意义（P〉0.05）。通过比较手术前后正侧位X线片发现3种手术方式的实施效果都比较好。末次随访时A组复发4例（乳腺癌2例,前列腺癌1例,甲状腺癌1例）,死亡3例（肺癌2例,甲状腺癌1例）;B组复发2例（乳腺癌与前列腺癌各1例）,死亡3例（肺癌、乳腺癌和肾癌各1例）;C组未见复发病例,死亡2例为肺癌。3种手术方式在肿瘤的复发和死亡情况方面比较差异有统计学意义（P〈0.05）,整块切除术优于大块切除术和碎块切除术。结论：3种手术方式均可缓解疼痛,改善神经功能,增加脊柱稳定性,控制局部病灶,提高患者的生存质量,但全脊椎整块切除术在手术时间、术中出血量、术中输血量和肿瘤复发与死亡情况方面明显优于大块切除术和碎块切除术。
Objective：To compare the therapeutic effects of debris spondylectomy,piecemeal spondylectomy,total en bloc spomdylectomy in treating lumbar metastatic tumors. Methods：The clinical data of 20 patients with lumbar metastatic tumors treated from January 2008 to October 2013 were retrospectively reviewed. There were 8 males and 12 females ,aged from 35 to 65 years old with an average of （49.50±9.97） years. All patients had single solitary metastases. Four cases were in L 1,5 cases in L2,4 cases in L3,4 cases in L4,and 3 cases in L5. According to the type of Tomita,typeⅡhad in 4 cases,typeⅢin 6 cases,typeⅣin 6 cases,type V in 4 cases. Tokuhashi score was 12.50±1.97. All patients complained with back or leg pain , VAS score was 8.13±0.85. Among patients,7 cases were treated with debris spondylectomy （group A）,7 cases with piecemeal spondylectomy （group B）,6 cases with total en bloc spondylectomy （group C）. Statistical analysis was used to compare the three groups with respect to surgical trauma （including operative time,transoperative bleeding,and intraoperative blood transfusion）,clinical symptoms （by VAS score at 1 week after operation）,surgical procedures conditions （by AP and lateral X rays）,and long term results （by recurrence and death information）. Results：All patients were followed up from 6 to 36 months with an average of （16.50±7.88） months. Operative time for debris spondylectomy was （6.14±0.68） h,intraoperative bleeding was（3 457.14±399.40） ml,and intraoperative blood transfusion was（2 771.43±423.14）ml. Operative time for piecemeal spondylectomy was（4.93±0.61） h,intraoperative bleeding was（1 942.86±378.51） ml,and intraoperative blood transfusion was （1 500.00±336.65）ml. Operative time for total en bloc spondylectomy was（4.17±0.67） h,intraoperative bleeding was （1 341.67±361.13） ml,and intraoperative blood transfusion was （916.67±321.66） ml. There was significant differences in operative time,intraoperative blood loss,and intraoperative blood transfusion between three groups （P〈0.05）. In terms of these factors,total en bloc spondylectomy had the best outcome followed by piecemeal spondylectomy. All pains had released ,VAS score decreased obviously at 1 week after operation（P〈0.05）,and there was no significant differences between three groups（P〉0.05）. Surgical effects were well with these methods according to the evaluation of AP and lateral X rays . At final follow up, group A had 4 recurrences（2 with breast cancer,1 with prostate cancer,and 1 with thyroid cancer） and 3 deaths （2 with lung cancer and 1 with thyroid cancer）;group B had 2 recurrences （1 with breast cancer and 1 with prostate cancer） and 3 deaths （1 with lung cancer,1 with breast cancer and 1 with kidney cancer）;group C had no recurrences and 2 deaths for lung cancer. There was significant differences in recurrence and death between three groups（P〈0.05）. In terms of these factors,total en bloc spondylectomy had the best outcome in three methods. Conclusion：Three kinds of operation method can relieve pain ,improve nerve function,increase the spinal stability,control the local lesions,improve the patient＆#39;s quality of life in treating lumbar metastatic tumors,but total en bloc spendylectomy,respect to operative time,transoperative bleeding,intraoperative blood transfusion,tumor recurrence and death is clearly superior to other two methods.
出处
《中国骨伤》
CAS
2014年第9期745-751,共7页
China Journal of Orthopaedics and Traumatology
关键词
腰椎
肿瘤转移
转移瘤
全脊椎切除
Lumbar vertebrae
Neoplasm metastasis
Metastatic tumor
Total spondylectomy
