一期后路全脊椎切除术治疗伴脊髓压迫的肾源性脊柱转移癌

目的探讨一期后路全脊椎切除术治疗伴有脊髓压迫的肾源性脊柱转移癌的外科策略及临床疗效。方法2003年1月—2012年12月,第二军医大学附属长征医院骨肿瘤科共收治35例伴有脊髓压迫的肾癌脊柱转移患者,均行一期后路全脊椎切除术、脊髓减压并内固定重建术。对所有患者病史、影像学资料、手术时间、术中出血量、切除重建策略、手术并发症及临床疗效进行分析。采用美国脊髓损伤协会(ASIA)分级评价患者神经功能状况,采用视觉模拟量表(VAS)评分对患者疼痛程度进行评估。所有患者术后接受放化疗以及双膦酸盐治疗。结果所有手术顺利完成,手术时间为(296±35)min,术中出血量为(2 160±240)m L,术中无大血管或脊髓损伤,无脑脊液漏等并发症。所有患者均获得随访,随访时间为(73.2±8.7)个月。术后1例ASIA A级患者恢复至B级;3例ASIA B级患者恢复至C级、D级各1例,1例因压迫时间过长无恢复;2例ASIA C级患者1例恢复至D级,1例仍然为C级;11例ASIA D级患者9例恢复至E级,2例仍然为D级;18例ASIA E级患者无变化。所有患者术后VAS评分均降低,与术前相比差异有统计学意义(P0.05)。随访时1例患者术后18个月因肿瘤复发压迫颈髓致瘫痪,并肺部转移,致呼吸衰竭死亡;2例患者复发,1例行手术治疗,1例放弃治疗;3例患者带瘤生存;其余患者末次随访时未见复发征象。结论一期后路全脊椎切除术治疗伴脊髓压迫的肾癌脊柱转移能够安全有效地解决患者局部压迫症状,改善其神经功能,术后综合治疗能延长患者的生存期。

One-stage total spondylectomy via posterior approach for renal carcinoma spinal metastases with spinal cord compression

Objective To explore the strategy and efficacy of one-stage total spondylectomy via posterior approach in treatment of renal carcinoma spinal metastases with spinal cord compression(SCC). Methods From January 2003 to December 2012,35 patients with SCC due to renal carcinoma spinal metastasis were treated with one-stage total spondylectomy via posterior approach,spinal cord decompression and internal fixation in Changzheng Hospital. The clinical history,imaging data,operation time,intraoperative blood loss,resection and reconstruction strategy,surgical complications and clinical efficacy were analyzed. The neurological status was assessed by the American Spinal Injury Association(ASIA) classification,and the visual analogue scale(VAS) score was used to assess the pain severity of the patients. All the patients received radiotherapy,chemotherapy and bisphosphonates. Results All the patients were operated successfully. The operation time was (296±35)min,and the blood loss was (2 160±240)mL. There were no complications as large vessel or spinal cord injury or cerebrospinal fluid leakage during the operative period. All the patients were followed up for (73.2±8.7)months. Based on the ASIA classification,1 patient recovered from grade A to grade B;1 from grade B to C,1 to D,and 1 remained at grade B because of long time compression;2 grade C patients recovered to grade D and remained at grade C in 1 respectively;11 grade D patients recovered to grade E in 9,and remained at grade D in 2;18 grade E patients remained unchanged. The postoperative VAS scores decreased in all the patients,and compared with the preoperation,the difference was statistically significant(P < 0.05). During the follow-up period,1 patient had tumor recurrence,compression of the spinal cord paralysis,and lung metastasis resulting in respiratory failure and death;In 2 relapsed patients,1 underwent surgical treatment,and the other gave up the treatment;3 patients survived with tumor;others were not found having recrudescent symptoms or signs. Concluson One-stage total spondylectomy via posterior approach for the treatment of renal carcinoma spinal metastases with SCC can safely and effectively elimilate the symptoms of local compression,and improve the neurological function of the patients. The postoperative comprehensive treatment can prolong the survival of the patients.