影响脊柱转移癌患者脊髓功能恢复的因素

背景:肿瘤脊柱转移常并发疼痛、活动受限及瘫痪,预后差。目的:探讨影响脊柱转移癌脊髓功能恢复的因素及其治疗方法,以期提高晚期癌症患者的生活质量。设计:病例自身对照观察。单位:广东医学院附属医院肿瘤科和放疗科。对象:选择1992-03/2001-06广东医学院附属医院肿瘤科收治的伴有不同程度瘫痪症状的脊柱转移癌患者162例,均自愿参加观察。方法:①放疗及化疗:所有患者均采用对症治疗并行单纯放射治疗或放疗与化疗综合治疗,其中放疗剂量为2Gy/次,5次/周,共进行3周;化疗根据不同原发肿瘤制定联合方案,化疗2～6个周期,平均3个周期,每个周期21d。②康复疗法包括运动疗法、按摩(2次/d)、功能性电刺激(1次/d)、排尿训练及排便训练(每天一两次),10d为1个疗程,连续3个疗程。治疗结束后观察止痛效果、肢体肌力及排便功能恢复情况。主要观察指标:治疗结束后患者疼痛缓解情况及肢体肌力、排便功能恢复情况。结果:162例患者全部进入结果分析,无脱落。①疼痛完全缓解97例(59.88%);无缓解0例。②肌力明显改善127例(78.40%),无改善35例(21.60%)。单发病灶及相邻2个椎体病灶患者,其肌力好转率为92.98%;多发病灶肌力好转率为64.59%。病史<2周的患者,治疗后肌力明显进步,>2个月的患者肌力无改善。21例患者治疗前CT或MRI显示病变段脊髓严重受压,治疗后仅2例肌力进步,其余无改善。③162例患者排便功能均恢复正常。结论:伴有瘫痪症状的脊柱转移癌患者经放疗、化疗及综合康复治疗后疼痛情况及肢体肌力、排便功能均有不程度的缓解和改善。影响其脊髓功能恢复的因素主要是病程长短、脊髓受压迫程度、转移病灶数量、患者体质情况及初次康复治疗时间、质量等。同时应注重对患者进行心理辅导,以提高其生活质量。

Factors affecting the recovery of spinal functions in patients with spinal metastatic carcinoma

BACKGROUND: Tumor spinal metastasis is often complicated with pain,limitations in movement, paralysis and poor prognosis.OBJECTIVE: To investigate the factors affecting the recovery of the spinal functions in patients with spinal metastatic carcinoma and its therapeutic methods so as to improve the living quality of the patients with a terminal cancer.DESIGN: A case-controlled observation.SETTING: The Department of Tumor and Department of Radiotherapy of the Affiliated Hospital of Guangdong Medical College.PARTICIPANTS: We selected 162 patients with spinal metastatic carcinoma with different degrees of paralysis who received treatment at the Department of Oncology and the Department of Radiotherapy of the Affiliated Hospital of Guangdong Medical College between March 1992 and June 2001. They participated in this experiment voluntarily.METHODS:①Radiotherapy and chemotherapy; All the patients were given symptomatic treatment with simple radiotherapy or a combined therapy of simple radiotherapy and chemotherapy, in which the dose of chemotherapy was 2 Gy/time,5 times a week,3 weeks in total. A combined method was used for chemotherapy according to the nature of the different primary tumors. The chemotherapy was conducted for 3 therapeutic courses in average ranging from 2 to 6 courses of treatment with 21 days for each course. ② Physical rehabilitation therapy included exercise therapy, massage (twice/day), functional electrical stimulation (once a day),bladder training and toilet training (once or twice every day), 10 days as a therapeutic course, 3 successive therapeutic courses in total. After the treatment, analgesic pain, muscle power of the limbs and the recovery of defecation function were observed.MAIN OUTCOME MEASURES: Pain-alleviating, muscle power of the limbs and the recovery of defecation function after the operation. RESULTS: Totally 162 patients with spinal metastasis carcinoma were recruited, and all the patients entered the stage of result analysis at the end of therapy with no loss in the midway. ① Pain complete alleviating was in 97 cases (59.88%); no alleveclting in 0 case. ② The condition was remarkably improved in 127 cases(78.40%), and it was not improved in 35 cases (21.60%). The improved rate of muscle power of the patients with one focus and 2 adjacent focuses was 92.98%. The improved rate of the patients with multiple foci was 64.59%. The muscle power of the patients with a disease history of less than 2 weeks was improved remarkably, but there was no change in muscle power in patients with a disease history of more than 2 months. CT or MRI showed that spinal cord at the affected segment of the 21 patients suffered severely compression before the treatment, and only 2 cases were improved in muscle power, with no other changes.③The defecation function of 162 patients all became normal.CONCLUSION: Patients with spinal metastatic carcinoma complicated with paralysis have different degrees of relief and amelioration in pain,muscle power of the limbs and defecation function after radiotherapy,chemotherapy and synthetic rehabilitation therapy. Factors affecting the recovery of spinal function mainly included the length of disease course,compressed degree of the spinal cord, the quantity of metastatic focus, the health status of the patients and therapeutic time and the quality of primary rehabilitation and so on. Mental help to the patients should be paid attention to so as to improve the quality of life at the same time.