经皮微波消融联合经皮穿刺椎体成形术治疗腰椎转移瘤的疗效

目的 观察微波消融（microwave ablation，MWA）联合经皮穿刺椎体成形术（percutaneous vertebroplasty，PVP）治疗腰椎转移瘤的临床疗效。方法 回顾性分析2016年6月至2019年6月广西医科大学附属肿瘤医院收治的50例腰椎转移瘤患者的临床资料，其中行经皮椎体成形术26例（PVP 组），经皮微波消融联合经皮椎体成形术24例（PVP+MWA组）。观察两组患者疼痛、功能状态以及骨水泥外渗情况和术后肿瘤复发率。结果 随访6～36个月，PVP组VAS评分从术前的（7.58±1.06） 分降至术后1个月的（3.27±1.40） 分和术后6个月的（3.08±1.60） 分；PVP+MWA组从术前的（7.67±1.05） 分降至术后1个月的（3.04±1.20） 分和术后6个月的（2.96±1.46） 分，两组术后 1个月及6个月的VAS评分低于术前（均P<0.05）,但重复测量方差显示，组间效应差异无统计学意义（F=0.223，P=0.801）。术后1个月，PVP组的KPS评分较术前提升（21.50±11.32） 分，PVP+MWA组较术前提升（19.92±13.19） 分，两者差异无统计学意义（t=0.457，P=0.650）。PVP+MWA 组的骨水泥外渗率（12.5% vs 38.5%，P=0.037）和肿瘤复发率（8.3% vs 30.8%，P=0.048）均低于PVP 组。结论 经皮穿刺椎体成形术单独或联合微波消融治疗腰椎转移瘤均可取得较好临床疗效，两者联合在减少骨水泥外渗及局部肿瘤控制中更有优势。 

The effect of percutaneous microwave ablation combined with percutaneous vertebroplasty in the treatment of lumbar metastases

Objective  To observe the clinical effect of microwave ablation combined with percutaneous vertebroplasty(PVP) in the treatment of lumbar metastases（MWA）. Methods A retrospective analysis was performed on the clinical data of 50 patients with metastatic tumors of the lumbar vertebrae admitted to Guangxi Medical University Cancer Hospital from June 2016 to June 2019, including 26 cases of percutaneous vertebroplasty (PVP group), and percutaneous microwave ablation combined 24 cases of skin vertebroplasty (PVP+MWA group). The pain, functional status, bone cement extravasation and postoperative tumor recurrence rate of the two groups of patients were observed. Results Followed up for 6 to 36 months, the VAS score of the PVP group decreased from (7.58±1.06) points before the operation to(3.27±1.40) points 1 month after the operation and(3.08±1.60) points 6 months after the operation; the PVP+MWA group reduced from(7.67±1.05) points before the operation to(3.04±1.20) points 1 month after surgery and(2.96±1.46) points 6 months after surgery. VAS scores of the two groups at 1 month and 6 months after surgery were lower than those before surgery (all P<0.05), but the variance of repeated measurements showed that no statistically significant difference between two groups(F=0.223, P=0.801). One month after surgery, the KPS score of the PVP group was increased by (21.50±11.32) points than that of the preoperative, and the KPS score of the PVP+MWA group was increased by (19.92±13.19) points than that of the preoperative, but there was no statistically significant difference (t=0.457, P=0.650). The bone cement exosmosis rate (12.5% vs 38.5%, P=0.037) and tumor recurrence rate (8.3% vs 30.8%, P=0.048) in PVP+MWA group were both lower than those in PVP group. Conclusions Percutaneous vertebroplasty alone or in combination with microwave ablation can achieve better clinical effects in the treatment of lumbar metastases. The combination of the two has advantages in the reduction of bone cement extravasation and local tumor control.