中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2014年
11期
1127-1133
,共7页
韩秀鑫%王国文%张超%多健%廖志超
韓秀鑫%王國文%張超%多健%廖誌超
한수흠%왕국문%장초%다건%료지초
脊柱%肿瘤转移%转移瘤切除术%治疗结果
脊柱%腫瘤轉移%轉移瘤切除術%治療結果
척주%종류전이%전이류절제술%치료결과
Spine%Neoplasm metastasis%Metastasectomy%Treatment outcome
目的 分析121例脊柱转移瘤患者采用以手术治疗为主综合治疗的疗效.方法 回顾性分析2009年4月至2013年3月121例脊柱转移瘤患者的病例资料,男69例,女42例;年龄37～65岁,平均为55.6岁.肺癌35例(28.9％)、乳腺癌26例(21.4％)、肾癌17例(14.0％)、前列腺癌20例(16.5％)、甲状腺癌14例(11.6％)、肝癌2例(1.7％)、结肠癌1例(0.8％)、其他肿瘤6例(5.0％).应用疼痛视觉模拟评分(visual analogue scale,VAS)于术前及术后3个月进行评估、Frankel分级评估脊髓损害恢复情况、Karnofsky体能状况评分(Kamofsky performance score,KPS评分)评估患者身体状况、观察二便恢复情况,EORTC QLQ-C30评分评估生活质量,Kaplan-meier法进行生存分析.结果 随访时间5～35个月,平均15.9个月,中位生存时间14.5个月.1年生存率53.5％,2年生存率36.5％.肺癌患者中位生存时间为8.5个月,1年生存率为14.3％,2年生存率11.4％;乳腺癌患者中位生存时间为31个月,1年生存率为57.7％,2年生存率为46.2％.术后3个月疼痛较术前明显缓解,差异有统计学意义.Frankel分级D、E级由术前的43.5％提高到术后的80.3％.KPS评分(80～100分)由术前的33.1％提高到术后的75.2％.术前二便障碍者术后有46.7％(35/75例)得到不同程度地缓解.EORTC QLQ-C30评分由术前(83.39±7.23)分改善至术后(51.34± 14.27)分,差异有统计学意义.结论 外科手术治疗脊柱转移瘤能有效地缓解患者疼痛、改善脊髓功能,使部分患者二便功能得以恢复,生存质量得到明显提高.乳腺癌及肺癌患者脊柱转移采用外科手术的比例较其他恶性肿瘤高;相对于乳腺癌,恶性程度更高的肺癌患者脊柱转移后采用外科手术干预的比例更高.
目的 分析121例脊柱轉移瘤患者採用以手術治療為主綜閤治療的療效.方法 迴顧性分析2009年4月至2013年3月121例脊柱轉移瘤患者的病例資料,男69例,女42例;年齡37～65歲,平均為55.6歲.肺癌35例(28.9％)、乳腺癌26例(21.4％)、腎癌17例(14.0％)、前列腺癌20例(16.5％)、甲狀腺癌14例(11.6％)、肝癌2例(1.7％)、結腸癌1例(0.8％)、其他腫瘤6例(5.0％).應用疼痛視覺模擬評分(visual analogue scale,VAS)于術前及術後3箇月進行評估、Frankel分級評估脊髓損害恢複情況、Karnofsky體能狀況評分(Kamofsky performance score,KPS評分)評估患者身體狀況、觀察二便恢複情況,EORTC QLQ-C30評分評估生活質量,Kaplan-meier法進行生存分析.結果 隨訪時間5～35箇月,平均15.9箇月,中位生存時間14.5箇月.1年生存率53.5％,2年生存率36.5％.肺癌患者中位生存時間為8.5箇月,1年生存率為14.3％,2年生存率11.4％;乳腺癌患者中位生存時間為31箇月,1年生存率為57.7％,2年生存率為46.2％.術後3箇月疼痛較術前明顯緩解,差異有統計學意義.Frankel分級D、E級由術前的43.5％提高到術後的80.3％.KPS評分(80～100分)由術前的33.1％提高到術後的75.2％.術前二便障礙者術後有46.7％(35/75例)得到不同程度地緩解.EORTC QLQ-C30評分由術前(83.39±7.23)分改善至術後(51.34± 14.27)分,差異有統計學意義.結論 外科手術治療脊柱轉移瘤能有效地緩解患者疼痛、改善脊髓功能,使部分患者二便功能得以恢複,生存質量得到明顯提高.乳腺癌及肺癌患者脊柱轉移採用外科手術的比例較其他噁性腫瘤高;相對于乳腺癌,噁性程度更高的肺癌患者脊柱轉移後採用外科手術榦預的比例更高.
목적 분석121례척주전이류환자채용이수술치료위주종합치료적료효.방법 회고성분석2009년4월지2013년3월121례척주전이류환자적병례자료,남69례,녀42례;년령37～65세,평균위55.6세.폐암35례(28.9％)、유선암26례(21.4％)、신암17례(14.0％)、전렬선암20례(16.5％)、갑상선암14례(11.6％)、간암2례(1.7％)、결장암1례(0.8％)、기타종류6례(5.0％).응용동통시각모의평분(visual analogue scale,VAS)우술전급술후3개월진행평고、Frankel분급평고척수손해회복정황、Karnofsky체능상황평분(Kamofsky performance score,KPS평분)평고환자신체상황、관찰이편회복정황,EORTC QLQ-C30평분평고생활질량,Kaplan-meier법진행생존분석.결과 수방시간5～35개월,평균15.9개월,중위생존시간14.5개월.1년생존솔53.5％,2년생존솔36.5％.폐암환자중위생존시간위8.5개월,1년생존솔위14.3％,2년생존솔11.4％;유선암환자중위생존시간위31개월,1년생존솔위57.7％,2년생존솔위46.2％.술후3개월동통교술전명현완해,차이유통계학의의.Frankel분급D、E급유술전적43.5％제고도술후적80.3％.KPS평분(80～100분)유술전적33.1％제고도술후적75.2％.술전이편장애자술후유46.7％(35/75례)득도불동정도지완해.EORTC QLQ-C30평분유술전(83.39±7.23)분개선지술후(51.34± 14.27)분,차이유통계학의의.결론 외과수술치료척주전이류능유효지완해환자동통、개선척수공능,사부분환자이편공능득이회복,생존질량득도명현제고.유선암급폐암환자척주전이채용외과수술적비례교기타악성종류고;상대우유선암,악성정도경고적폐암환자척주전이후채용외과수술간예적비례경고.
Objective To investigate the safety and efficacy of surgery in 121 patients with spinal metastases.Methotds A retrospective analysis of clinical data from April 2009 to March 2013 was performed in 121 patients with spinal metastases.From 37 to 65 years,69 males and 42 females with mean age of 55.6 years.Primary tumor origin:Lung 35(28.9％),Breast 26(21.4％),Renal 17 (14.0％),Prostate 20 (16.5％),Thyroid 14 (11.6％),Liver 2 (1.7％),Colon 1 (0.8％),other 6 (5.0％).All patients received surgery.Follow-up and survival time were analyzed.In preoperation and postoperative 3 month,pain levels were assessed by visual analogue scale (VAS),neurologic deficit was evaluated by Frankel Grade and functional impairment was classified by Karnofsky Score.The quality of the life was assessed by EORTC QLQ-C30 questionnaire.Survival analysis was evaluated by Kaplan-meier.Results The period of follow-up ranged from 5 to 35 months with the average of 15.9 months.The mean survival was 14.5 months.1-year survival was 53.5％.2-year survival was 36.5％.In patients with lung cancer,the mean survival was 8.5months.1-year survival was 14.3％.2-year survival was 11.4％.In patients with breast cancer,the mean survival was 31 months.1-year survival was 57.7％.2-year survival was 46.2％.In preoperation and postoperative 3 month,the VAS showed statistical significance (t=21.6,P＜0.01) ;Post-operatively,80.3％ of all patients had functionally useful Frankel Grade D or E compared with 43.5％ pre-operatively.KPS score (80-100) percentage was 75.6％ postoperatively compared with 33.4％ preoperatively.In 1month postoperatively,35 of 75 patients who were sphincteric dysfunction preoperatively were improved.The EORTC QLQ-C30score was 83.39±7.23 in preoperation and 51.34±14.27 in postoperaion.The quality of life was impoved significantly (t=12.6,P＜0.01).Conclusion Surgical treatment was effective in improving quality of life by providing better pain control,enabling patients to regain or maintain mobility,and offering improved sphincter control.In all patients,the number of patents with spinal metastases from breast and lung cancer is higher.Compared with spinal metastases from breast cancer,the proportion of lung cancer origin received surgery is higher.
