一期后路分块与整块全脊椎切除术在胸腰椎恶性肿瘤中的效果  

Effect of one-stage posterior piecemeal and en-bloc resection of thoracolumbar malignant tumor

作　　者：芦山[1] 孟宇[1] 李弘帅[1] 王楠[1] 陈聚伍[1] LU Shan;MENG Yu;LI Hongshuai;WANG Nan;CHEN Juwu(Department of Emergency Medicine,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,He’nan,China)

机构地区：[1]郑州大学第一附属医院急诊医学部,郑州450000

出　　处：《癌症进展》2021年第16期1670-1673,共4页Oncology Progress

摘　　要：目的研究胸腰椎恶性肿瘤使用一期后路分块与整块全脊椎切除术的效果。方法将92例胸腰椎恶性肿瘤患者根据其手术治疗方案不同分为分块组和整块组,每组46例,其中分块组患者采用一期后路分块全脊椎切除术,整块组患者采用一期后路整块全脊椎切除术。观察两组患者的围手术期指标(手术时间、术中输血量、术中出血量、术后引流量),比较两组患者术前1天、术后6个月简化McGill疼痛问卷量表(SF-MPQ)评分,分析两组患者术前、术后1年的Frankel脊髓损伤分级情况,统计末次随访结束后两组患者的并发症总发生率、局部复发率、生存率。结果整块组患者手术时间明显长于分块组,分块组患者术中输血量、术中出血量、术后引流量均明显高于整块组,差异均有统计学意义(P﹤0.01)。手术前后,两组患者SF-MPQ量表中各指标评分、Frankel脊髓损伤分级情况比较,差异均无统计学意义(P﹥0.05);术后,两组患者SF-MPQ量表中各指标评分均明显低于本组术前,Frankel脊髓损伤分级情况均明显优于本组术前,差异均有统计学意义(P﹤0.01)。两组患者术后随访1年并发症总发生率、总生存率比较,差异均无统计学意义(P﹥0.05);整块组患者术后随访1年局部复发率低于分块组,差异有统计学意义(P﹤0.05)。结论一期后路分块与整块全脊椎切除术对胸腰椎恶性肿瘤临床治疗效果均较好,其中整块切除方案虽耗时较长,但其能有效降低患者术中输血量,减少术中出血及术后引流量,且在预防局部复发方面优势明显。Objective To study the effect of one-stage posterior piecemeal and en-bloc resection for thoracolumbar malignant tumor.Method A total of 92 patients with thoracolumbar malignant tumor were divided into en-bloc group(n=46)and piecemeal group(n=46)according to their different surgical treatment schemes.The patients in the piecemeal group were treated with one-stage posterior piecemeal total spondylotomy,and the en-bloc group were treated with onestage posterior en-bloc total spondylotomy.The perioperative indicators(operation time,intraoperative blood transfusion,intraoperative blood loss and postoperative drainage volume)were observed in the two groups.The short-form McGill pain questionnaire(SF-MPQ)score was recorded 1 day before operation and 6 months after operation.Frankel spinal cord injury grade was used before and 1 year after operation.The incidence of complications,local recurrence rate and overall survival rate after the last follow-up were calculated.Result The operation time of the en-bloc group was significantly higher than that of the piecemeal group,the intraoperative blood transfusion volume,intraoperative blood loss and postoperative drainage volume of the piecemeal group were significantly higher than those of the en-bloc group(P<0.01).There was no significant differences in the pain scores of SF-MPQ scale before and after operation between the two groups(P>0.05);after operation,the pain scores of SF-MPQ scale in both groups were significantly lower than those before operation(P<0.01),and the Frankel spinal cord injury classification in both groups were significantly better than those before operation(P<0.01).There were no significant differences in the incidence of complications and overall survival rate between the two groups after 1-year follow-up(P>0.05),and the 1-year local recurrence rate in the en-bloc group was lower than that in the piecemeal group(P<0.05).Conclusion The one-stage posterior en-bloc and piecemeal spinal resection are effective in the treatment of thoracolumbar malignant t

关 键 词：脊柱肿瘤 胸腰椎肿瘤 全脊椎切除 整块切除 分块切除 

分 类 号：R738[医药卫生—肿瘤]