PVP 联合动脉栓塞化疗术治疗复杂性脊柱转移肿瘤  

Combination treatment of vertebral and paravertebral metastastic tumors by transarterial chemoembolization and percutaneous vertebroplasty

作　　者：何仕诚[1] 滕皋军[1] 方文[1] 邓钢[1] 郭金和[1] 朱光宇[1] 李国昭[1] 

机构地区：[1]东南大学附属中大医院放射科,南京210009

出　　处：《中华医学杂志》2011年第3期175-179,共5页National Medical Journal of China

基　　金：江苏省科技厅2006年度社会发展项目 （BS2006048）

摘　　要：目的 探讨经皮椎体成形术（PVP）联合动脉栓塞化疗术治疗复杂性脊柱转移肿瘤的疗效和安全性.方法 收集2003年3月至2009年12月东南大学附属中大医院内科放化疗后疼痛无缓解的复杂性脊椎转移肿瘤患者49例共72节,背部疼痛评价多为重度,其中合并下肢放射痛17例、双下肢不同程度瘫痪6例.选择性椎体动脉栓塞化疗术后6 d内行PVP,PVP后3 d内CT复查观察PMMA分布及渗漏情况,采用VAS评分及WHO疼痛标准评价疗效,定期随访.结果 双侧椎体动脉选择性插管有44例65节,仅选择人单侧有5例7节.用碘化油1～2 ml＋明胶海绵颗粒栓塞29节,单纯用明胶海绵颗粒栓塞41节,单纯灌注化疗2节.平均注入PMMA胸椎4.23 ml,腰椎5.39 ml.联合治疗后3个月CR 21例（42.9%）、PR 22例（44.9%）、MR及NR6例（12.2%）,总有效率87.8%.CT证实12例椎体周围PMMA渗漏16节,均无临床症状,无其他严重并发症发生.结论 椎体动脉栓塞化疗和PVP都是脊椎转移性肿瘤的有效治疗手段,二者联合可显著提高椎体合并附件及椎旁转移肿瘤患者的疗效.Objective To evaluate the efficacy and safety of combining transarterial chemoembolization and percutaneous vertebroplasty （PVP） in the treatment of vertebral and paravertebral metastatic tumors. Methods A retrospective review was conducted in 49 patients with severer painful tumor metastasis in 72 vertebrae and paravertebral tissue who had failed noninvasive treatment at our institution from March 2003 to December 2009. Among them, there were intractable radicular pain （ n = 17） and slight or no motor and sensory function （ n = 6）. All patients under transarterial chemoembolization were followed within 6 days by PVP. Computed tomography （CT） was performed within 3 days after PVP to observe the distribution of PMMA （ para-methoxymethamphetamine ） in vertebrae and whether or not there was any leakage. The efficacy was assessed by the change of pain level after combined treatment. Results Bilateral vertebral arteries were selected in 44 cases with 65 vertebrae. And only unilateral vertebral artery was selected in 5 cases with 7 vertebrae. Except for 2 vertebrae with simple artery infusion, 29 vertebrae were embolized by 1-2 ml of lipiodolization and gelfoam particles and 41 vertebrae by gelatine particles. And an average volume of 4. 23 ml and 5.39 ml was injected in each thoracic and lumbar vertebra respectively. The rate of efficacy was at 87. 8% within 3 months after combined therapy. There were CR（ complete response）21cases （42. 9% ）, PR （partial response） 22 cases（44.9%）and MR/NR （minimal/no response） 6 cases （12. 2% ）. No serious complication related to the technique occurred. Only 12 cases with asympotomatic PMMA leakage around 16 vertebrae were demonstrated on post-operative CT. Conclusion Transarterial chemoembolization plus PVP is an effective and safe procedure in the treatment of severe painful vertebral and paravertebral metastatic tumors.

关 键 词：椎体转移性肿瘤 动脉栓塞化疗 椎体成形术 骨水泥 

分 类 号：R738[医药卫生—肿瘤]