CAJ | 학술논문

目的探讨经皮椎体成形术(PVP)联合动脉栓塞化疗术治疗复杂性脊柱转移肿瘤的疗效和安全性.方法收集2003年3月至2009年12月东南大学附属中大医院内科放化疗后疼痛无缓解的复杂性脊椎转移肿瘤患者49例共72节,背部疼痛评价多为重度,其中合并下肢放射痛17例、双下肢不同程度瘫痪6例.选择性椎体动脉栓塞化疗术后6 d内行PVP,PVP后3 d内CT复查观察PMMA分布及渗漏情况,采用VAS评分及WHO疼痛标准评价疗效,定期随访.结果双侧椎体动脉选择性插管有44例65节,仅选择人单侧有5例7节.用碘化油1～2 ml+明胶海绵颗粒栓塞29节,单纯用明胶海绵颗粒栓塞41节,单纯灌注化疗2节.平均注入PMMA胸椎4.23 ml,腰椎5.39 ml.联合治疗后3个月CR 21例(42.9%)、PR 22例(44.9%)、MR及NR6例(12.2%),总有效率87.8%.CT证实12例椎体周围PMMA渗漏16节,均无临床症状,无其他严重并发症发生.结论椎体动脉栓塞化疗和PVP都是脊椎转移性肿瘤的有效治疗手段,二者联合可显著提高椎体合并附件及椎旁转移肿瘤患者的疗效.
목적 탐토경피추체성형술(PVP)연합동맥전새화료술치료복잡성척주전이종류적료효화안전성.방법 수집2003년3월지2009년12월동남대학부속중대의원내과방화료후동통무완해적복잡성척추전이종류환자49례공72절,배부동통평개다위중도,기중합병하지방사통17례、쌍하지불동정도탄탄6례.선택성추체동맥전새화료술후6 d내행PVP,PVP후3 d내CT복사관찰PMMA분포급삼루정황,채용VAS평분급WHO동통표준평개료효,정기수방.결과 쌍측추체동맥선택성삽관유44례65절,부선택인단측유5례7절.용전화유1～2 ml+명효해면과립전새29절,단순용명효해면과립전새41절,단순관주화료2절.평균주입PMMA흉추4.23 ml,요추5.39 ml.연합치료후3개월CR 21례(42.9%)、PR 22례(44.9%)、MR급NR6례(12.2%),총유효솔87.8%.CT증실12례추체주위PMMA삼루16절,균무림상증상,무기타엄중병발증발생.결론 추체동맥전새화료화PVP도시척추전이성종류적유효치료수단,이자연합가현저제고추체합병부건급추방전이종류환자적료효.
Objective To evaluate the efficacy and safety of combining transarterial chemoembolization and percutaneous vertebroplasty (PVP) in the treatment of vertebral and paravertebral metastatic tumors. Methods A retrospective review was conducted in 49 patients with severer painful tumor metastasis in 72 vertebrae and paravertebral tissue who had failed noninvasive treatment at our institution from March 2003 to December 2009. Among them, there were intractable radicular pain ( n = 17) and slight or no motor and sensory function ( n = 6). All patients under transarterial chemoembolization were followed within 6 days by PVP. Computed tomography (CT) was performed within 3 days after PVP to observe the distribution of PMMA ( para-methoxymethamphetamine ) in vertebrae and whether or not there was any leakage. The efficacy was assessed by the change of pain level after combined treatment. Results Bilateral vertebral arteries were selected in 44 cases with 65 vertebrae. And only unilateral vertebral artery was selected in 5 cases with 7 vertebrae. Except for 2 vertebrae with simple artery infusion, 29 vertebrae were embolized by 1-2 ml of lipiodolization and gelfoam particles and 41 vertebrae by gelatine particles. And an average volume of 4. 23 ml and 5.39 ml was injected in each thoracic and lumbar vertebra respectively. The rate of efficacy was at 87. 8% within 3 months after combined therapy. There were CR( complete response)21cases (42. 9% ), PR (partial response) 22 cases(44.9%)and MR/NR (minimal/no response) 6 cases (12. 2% ). No serious complication related to the technique occurred. Only 12 cases with asympotomatic PMMA leakage around 16 vertebrae were demonstrated on post-operative CT. Conclusion Transarterial chemoembolization plus PVP is an effective and safe procedure in the treatment of severe painful vertebral and paravertebral metastatic tumors.