微波原位消融术治疗单节段胸-腰-骶椎体转移瘤的临床疗效评估  

Evaluation of clinical efficacy of microwave ablation in situ for thoracic, lumbar and sacral spinal metastases

作　　者：于哲 张明华 高铜栓 丁瑞 范清宇 Yu Zhe;Zhang Minghua;Gao Tongshuan;Ding Rui;Fan Qingyu(Department of Orthopedic Surgery,Orthopedics Oncology Institute of Chinese PLA,Tangdu Hospital,Air Force Military Medical University,Xi′an 710038,China)

机构地区：[1]空军军医大学第二附属医院骨肿瘤科,西安710038

出　　处：《中华放射肿瘤学杂志》2021年第3期253-257,共5页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金(31670940)。

摘　　要：目的探讨微波原位消融术治疗单节段胸、腰、骶椎体转移瘤的临床疗效。方法对28例单节段胸、腰、骶椎体转移瘤患者制订微波原位消融治疗的术前计划,在G型臂引导全麻下行后路椎板减压、游离脊髓和神经根加以降温保护的前提下,使用微波天线对病变椎体、椎弓进行微波消融处理,刮除病变组织后使用骨水泥重建骨质缺损区。术后随访1年,复查正侧位X线片、MRI等影像学检查,对疼痛、术后神经功能进行临床评估。结果 28例胸、腰、骶椎转移瘤患者均成功实施微波消融术,平均消融时间为8 min,平均植入骨水泥量为平均10.5 ml。术前和术后3个月患者数字疼痛分级法疼痛评分分别为(7.86±1.58)分和(3.07±1.89)分(P<0.05)。22例患者神经功能较术前改善,5例患者神经功能较术前无明显变化,1例患者患侧肢体神经功能缓解,健侧肢体症状略加重。结论微波原位消融术治疗单节段胸、腰、骶椎体转移瘤具有术野清晰、创伤小、出血少、安全界限可靠等特点,能有效缓解患者疼痛、限制肿瘤生长、提高患者生存质量,是一种有推广前景的治疗胸、腰、骶椎转移瘤的新术式。Objective To evaluate the clinical outcomes of patients with single spinal metastasis of thoracic,lumbar or sacral vertebra treated with microwave ablation in situ.Methods For 28 patients with single spinal metastasis of thoracic,lumbar or sacral vertebra,detailed and personal surgical plans were carried out.Instead of en bloc resection,hyperthermia ablation in situ was performed followed by strengthening procedures under the guidance of G-arm fluoroscopy machine.Intraoperatively,spinal cord and nerve root were properly protected.The bone defects were reconstructed by bone cement after the diseased lesions were revomed.All patients were followed up for almost 1 year postoperatively.During follow-up,X-ray and MRI images were obtained,and the level of pain and neurologic outcomes were also examined.Results All 28 patients successfully received microwave ablation in situ.The average ablation time was approximately 8 minutes and the average amount of bone cement implanted was approximately 10.5 ml.The pain scores of digital pain classification before and 3 months after operation were 7.86±1.58 and 3.07±1.89(P<0.05).The postoperative neurological function of 22 patients was improved than that before operation.No significant changes were observed in 5 patients.The neurological function of the affected limb was relieved,whereas the symptoms of the healthy limb were slightly worse in the remaining case.Conclusions Microwave ablation in situ is a feasible and effective surgical method for single spinal metastasis of thoracic,lumbar or sacral vertebra.It might possess many advantages,such as clear surgical field,smaller incisions,less bleeding,and safe margins during the operations.Further more,it could significantly relieve pain,restrict tumor growth,and improve the quality of life of patients.It is an innovative and distinctive therapeutic alternative for single spinal metastasis,which deserves widespread application.

关 键 词：脊柱转移肿瘤/微波消融疗法 治疗结果 并发症 

分 类 号：R738[医药卫生—肿瘤]