121例脊柱转移瘤手术治疗的疗效分析  

Survival analysis of 121 patients with spinal metastases accepted spinal surgery

作　　者：韩秀鑫[1] 王国文[1] 张超[1] 多健[1] 廖志超[1] 

机构地区：[1]天津医科大学肿瘤医院骨与软组织肿瘤科,国家肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,300060

出　　处：《中华骨科杂志》2014年第11期1127-1133,共7页Chinese Journal of Orthopaedics

基　　金：基金项目：国家肿瘤临床医学研究中心培育项目

摘　　要：目的分析121例脊柱转移瘤患者采用以手术治疗为主综合治疗的疗效。方法回顾性分析2009年4月至2013年3月121例脊柱转移瘤患者的病例资料，男69例，女42例；年龄37~65岁，平均为55．6岁。肺癌35例（28．9％）、乳腺癌26例（21．4％）、肾癌17例（14．O％）、前列腺癌20例（16．5％）、甲状腺癌14例（11．6％）、肝癌2例（1．7％）、结肠癌1例（0．8％）、其他肿瘤6例（5．0％）。应用疼痛视觉模拟评分（visualanaloguescale，VAS）于术前及术后3个月进行评估、Frankel分级评估脊髓损害恢复情况、Karnofsky体能状况评分（Karnofskyperformancescore，KPS评分）评估患者身体状况、观察二便恢复情况，EORTC QLQ—C30评分评估生活质量，Kaplan—meier法进行生存分析。结果随访时间5-35个月，平均15．9个月，中位生存时间14．5个月。1年生存率53．5％，2年生存率36．5％。肺癌患者中位生存时间为8．5个月，1年生存率为14．3％，2年生存率11．4％；乳腺癌患者中位生存时间为31个月，1年生存率为57．7％，2年生存率为46．2％。术后3个月疼痛较术前明显缓解，差异有统计学意义。Frankel分级D、E级由术前的43．5％提高到术后的80．3％。KPS评分（80-100分）由术前的33．1％提高到术后的75．2％。术前二便障碍者术后有46．7％（35／75例）得到不同程度地缓解。EORTCQLQ-C30评分由术前（83．39±7．23）分改善至术后（51．34±14．27）分，差异有统计学意义。结论外科手术治疗脊柱转移瘤能有效地缓解患者疼痛、改善脊髓功能，使部分患者二便功能得以恢复，生存质量得到明显提高。乳腺癌及肺癌患者脊柱转移采用外科手术的比例较其他恶性肿瘤高；相对于乳腺癌，恶性程度更高的肺癌患者脊柱转移后采用外科手术干预的比例更高。Objective To investigate the safety and efficacy of surgery in 121 patients with spinal metastases. Meth- ods A retrospective analysis of clinical data from April 2009 to March 2013 was performed in 121 patients with spinal metasta- ses. From 37 to 65 years, 69 males and 42 females with mean age of 55.6 years. Primary tumor origin： Lung 35（28.9%）, Breast 26 （21.4%）, Renal 17 （14.0%）, Prostate 20 （16.5%）, Thyroid 14 （11.6%）, Liver 2 （1.7%）, Colon 1 （0.8%）, other 6 （5.0%）. All patients received surgery. Follow-up and survival time were analyzed. In preoperation and postoperative 3 month, pain levels were assessed by visual analogue scale （VAS）, neurologic deficit was evaluated by Frankel Grade and functional impairment was classified by Karnofsky Score. The quality of the life was assessed by EORTC QLQ- c30 questionnaire. Survival analysis was evaluated by Ka- plan-meier. Results The period of follow-up ranged from 5 to 35 months with the average of 15.9 months. The mean survival was 14.5 months. 1-year survival was 53.5%. 2-year survival was 36.5%. In patients with lung cancer, the mean survival was 8.5 months. 1-year survival was 14.3%. 2-year survival was 11.4%, In patients with breast cancer, the mean survival was 31 months. 1- year survival was 57.7%. 2-year survival was 46.2%. In preoperation and postoperative 3 month, the VAS showed statistical significance （t=21.6, P〈0.01 ） ; Post-operatively, 80.3% of all patients had functionally useful Frankel Grade D or E compared with 43.5% pre-operatively. KPS score （80-100） percentage was 75.6% postoperatively compared with 33.4% preoperatively. In 1 month postoperatively, 35 of 75 patients who were sphincteric dysfunction preoperatively were improved. The EORTC QLQ-C30 score was 83.39±7.23 in preoperation and 51.34±14.27 in postoperaion. The quality of life was impoved significantly （t= 12.6, P〈 0.01）. Conclusion Surgical treatment was effective in improving quality of life by providing better pain control, ena

关 键 词：脊柱 肿瘤转移 转移瘤切除术 治疗结果 

分 类 号：R738.1[医药卫生—肿瘤]