脊柱转移肿瘤手术治疗风险和预后分析

目的　探讨脊柱转移肿瘤的手术治疗风险和预后。方法　 1992年 6月至 2 0 0 2年 6月手术治疗脊柱转移肿瘤 6 3例 ,其中前路椎体全部或部分切除脊髓减压、内固定 4 1例 ,后路椎板切除脊髓减压加内固定 8例 ,一期前后路肿瘤切除固定 14例。手术后随访 6个月以上。结果　术后X线显示所有患者均取得脊柱的稳定。除 1例术后 3d死亡外 ,有 5 7例 (91.9% )患者疼痛有显著的缓解或消失 ,4 1例 (6 6 .1% )患者的神经系统症状和体征有较大的改善。手术中无严重并发症发生。本组术后平均生存时间 13.5 9个月 ,肺癌和肝癌转移组的平均生存时间为 6个月 ,乳腺、胃肠道、前列腺癌和其他肿瘤转移组的平均生存时间为 15个月 ,甲状腺和肾癌的平均生存时间为 2 8个月 ,3组间差异有显著性 (P <0 .0 1)。结论　脊柱转移肿瘤手术能够缓解患者的疼痛 ,改善患者的生存质量。患者生存时间与原发肿瘤类型有关 ,肺癌和肝癌脊柱转移者生存时间较短 ,甲状腺癌和肾癌生存时间最长。

Risk factors and prognosis of surgery for spinal metastasis

Objective To evaluate the risk factors and prognosis of surgery for spinal metastasis. Methods A retrospective analysis was performed in 63 patients with spinal metastasis who underwent surgical treatment between June 1992 and June 2002. Forty-one patients underwent anterior en-bloc or partial resection,decompression and reconstruction with internal fixation of the spine. Laminectomy and decompression with internal fixation were done in 8 patients. One-stage anterior-posterior en-bloc resection and decompression followed by reconstructive stabilization were done in 14 patients. Results Having been followed up more than 6 months,postoperative radiological evaluation revealed that spinal stabilization was evident in all patients. Fifty-seven (91.9%) patients benefited with quality of life significantly improved through pain alleviation,41(66.1%) patients improved in their neurological status. No serious complications were observed in surgery. The mean survival time after surgery was 6 months in patients with lung and liver carcinoma,15 months in breast,prostatic,and stomach carcinoma as well as the other miscellaneous malignancies and 28 months in thyroid,kidney carcinoma among which groups the difference were significant(P<0.01). Conclusion Surgical treatment for spinal metastasis is able to relieve neurological symptoms and improve the quality of life. The survival time is related to the site of primary tumor;shorter survival in lung and liver carcinoma,longer in breast,prostatic,stomach carcinoma and longest in thyroid and kidney carcinoma.