肿瘤切除手术与姑息减压手术治疗脊柱转移瘤的临床疗效和生存期分析

目的]比较肿瘤切除手术与姑息减压手术治疗脊柱转移瘤的临床疗效、并发症和生存时间,以利于更好的适应证选择.方法]对2002年11月～2010年11月38例行肿瘤切除手术和45例行姑息切除减压手术的脊柱转移瘤患者临床评估并进行随访,平均随访17个月(3 ～91个月).采用VAS评分、ECOG评分、Frankel分级对疼痛、功能状况和脊髓功能进行评价.使用Kaplan-Meier法评估生存率.结果]切除组中位手术时间360 min,姑息组240 min (P＜0.000 1).切除组中位出血量3 500 ml,姑息组中位出血量1 200ml (P＜0.000 1).切除手术和姑息减压手术的VAS评分和ECOG评分在术后1个月均显著降低,两组间疼痛缓解和功能状况改善比较差异无统计学意义(P＞0.05).切除组术前有脊髓功能障碍的患者术后85％ Frankel分级得到改善,姑息组为83％.术后切除组18％神经功能再次恶化,中位时间13个月.姑息组31％神经功能再次恶化,中位时间6个月.切除手术组8例发生并发症(21.1％),姑息组9例(20％).切除组中位生存时间为22个月,姑息组为9个月(P =0.001).结论]肿瘤姑息切除减压手术出血少,时间短,风险小,适用于有严重不稳定疼痛、硬膜或神经根压迫的一般情况较差、预期生存期3～6个月的患者,是有价值的治疗方法.对于预期生存期＞6个月的患者,尽可能切除肿瘤,达到中长期的局部控制.

Clinical outcome and survival analysis after excisional and palliative decompression surgeries for spinal metastasis

Objective] To compare the clinical outcome,complications and survival of excisional surgery and palliative decompression surgery with spinal metastasis for better selection of the reasonable treatment.Method]We compared 38 patients treated by excisional surgery and 45 patients treated by palliative decompression surgery for spinal metastasis between November 2002 and November 2010.The mean postoperative follow-up was 17 months(3-19 months).Pain was measured with a visual analogue scale(VAS),functional outcome with Eastern Cooperative 0ncology Group scale(ECOG),Frankel scale for neurologic deficit and the Kaplan-Meier curve for survival.Result]The median operative time in the excisional surgery and the palliative surgery were 360 minutes and 240 minutes(P<0.000 1).The median blood loss in the excisional surgery and the palliative surgery were 3500 ml and 1200ml(P<0.000 1).The VAS and ECOG decreased at 1 month after treatment in both groups,with statistically significant improvement.The comparisons of improvements of either pain or performance status between the two managements both showed no statistically significant difference(P>0.05).For the excisional group,the Frankel scale was improved in 85% patients with neurologic deficit.While the improvement for the palliative group was in 83% patients.The neurologic function deteriorated in 18% patients in the excisional group,the median time was 13 months.The neurologic function deteriorated in 31% patients in the palliative group,the median time was 6 months.Eight patients(21%) by excisional surgery and 9 patients(20%) by palliative surgery underwent complications.The median survival time of the excisional group was 22 months and that of the palliative group was 9 months(P=0.001).Conclusion]The palliative decompression surgery is a valuable management with less operative time,blood loss and risk.It should be considered in the cases of dural sac or nerve root compression,severe spinal instability with poor general conditions and an anticipated survival time of greater than 3 to 6 months.Excisional surgery is recomended for a middle-long term local control in patients with an anticipated survival time of greater than 6 months.