脊柱转移癌局部复发再手术治疗

目的探讨脊柱转移癌局部复发伴脊髓及/或神经根压迫患者再手术治疗适应证的选择及其临床效果。方法对19例局部复发的脊柱转移癌患者行再手术治疗(局部肿瘤彻底切除或肿瘤大部切除环形减压),患者术后定期随访,对患者神经功能水平进行评价,并通过MRI,CT及X线片等评估肿瘤局部复发情况。分析患者局部复发原因、手术适应证及预后。结果 16例患者行局部肿瘤彻底切除,平均手术时间142 min,术中平均出血量1 447 m L;3例患者行肿瘤大部切除环形减压,平均手术时间107 min,术中平均出血量783 m L。术后所有患者平均随访34.7个月,术后神经功能较术前均有不同程度改善,术后生活质量明显提高。患者局部复发主要由于初次手术未能彻底切除病灶及缺乏有效的辅助治疗措施。结论对于脊柱转移癌局部复发伴脊髓及/或神经根再次压迫的患者,在全身状况较好的情况下,仍可考虑再次手术并结合多学科综合治疗,控制肿瘤局部复发,挽救神经功能,提高患者生存质量,甚至延长生存期,但对于手术适应证需严格把握。

Reoperation treatment for recurrence spinal metastatic tumors

Objectives To investigate the indication of reoperation treatment for recurrence spinal metastatic tumors with spinal cord and/or nerve root compression, and to evaluate the clinical effect. Methods Surgical treatments (Radical resection of tumors or circumferencial decompression) and follow-up were performed on 19 patients with recurrence spinal metastatic tumors. MRI, CT and roentgenograph were used to evaluate the local controal, and Frankel classification was used to evaluate the neurolocigal outcome. Recurrence reasons, surgical indications and prognosis were also analyzed. Results Sixteen patients underwent radical tumor resection with a mean time of 142 min, the mean blood loss was 1 447 mL, and 3 patients underwent circumferencial decompression with a mean time of 107 min and a mean blood loss of 783 mL. The mean time of follow-up was 34.7 months. Most patients' nurological status and quality of lives were conspicuously upgraded. Reasons of tumor local recurrence were insufficient primary surgery and lack of effective adjuvant therapies. Conclusions Surgery and effective adjuvant therapies with restricted indications, which could control tumor growth, save neurological functions, upgraded quality of life or even prolong the life expectancy, could be considered as effective measures for patients who suffered recurrence metastatic spinal lesions with moderate general conditions.