【摘要】 目的:报告一种新的脊柱转移性肿瘤的外科治疗策略的疗效,分析该策略的特点和合理性。方法:1996年1月至2006年12月在博洛尼亚Maggiore医院矫形创伤及脊柱外科接受过外科治疗的脊柱转移瘤患者249例,男152例,女97例;年龄15～79岁。按照自行制定的治疗新策略确定治疗方案。根据手术风险的麻醉评估判定手术的可行性:手术风险较低者,可考虑手术治疗;手术风险较高者,不适合外科手术,必须先采取保守治疗。可逆性神经功能损害、病理性骨折、顽固性疼痛以及辅助治疗不敏感者均作为手术指征。手术方式主要分为姑息性手术、刮除手术和整块切除手术。结果:1例术中死亡,共6例术后1月内死亡。91.7%患者疼痛术后明显缓解,88.4%患者术后即时神经功能改善。215例患者平均随访20.4个月,中位生存期为20.9±2.7个月。84.8%的患者得到了良好的局部控制。结论:脊柱转移性肿瘤的外科治疗仍然以改善患者的生存质量为主要目的,而合理的手术治疗能明显地改善患者的生存期和生存质量。术前麻醉风险的评估能较好地保证手术的安全性。依靠量化的评分系统决定脊柱转移瘤的治疗方式存在一定局限性,而个体化、灵活性高的治疗新策略在体现外科治疗的优势的同时强调辅助治疗的重要性,更加科学、合理,所以能够得到较好的疗效。更多还原

【Abstract】 Objective:To report the outcome of a new surgical strategy for metastatic spinal tumors and to discuss the characteristics and feasibility of this strategy.Methods:From January 1996 to December 2006,249 patients with spinal metastasis underwent surgical treatment in the Department of Orthopedics and Traumatology-Spine Surgery of Ospedale Maggiore, Bologna.There were 152 men and 97 women.The average age was 57 years.A new surgical strategy was examined in this study.According to this strategy,feasibility judgments were based on the anesthetic evaluation.Patients with lower potential risk for surgery were judged to be operable,whereas those with high potential risk for surgery were judged to be inoperable.Reversible neurological deficit,pathological fracture,intractable pain and insensitivity to the adjunctive therapies were all considered when making the judgment.The surgeries included 3 main procedures:palliative surgery,curettage surgery and en bloc surgery.Results:One patient died during the procedure and six patients died within 1 month after the procedure.Among the patients,91.7% had pain that was relieved and 88.4% had neurological functions improve immediately after the operation.There were 215 patients who were followed up with a mean time of 20.4 months and the median survival duration was 20.9±2.7 months.Among the patients followed up,84.8% achieved local control.Conclusion: The main purpose of surgical management of spinal metastases is to improve the quality of life.It was found that reasonable surgeries can significantly improve the survival time and quality of life.The preoperative anesthetic evaluation is critical for improved safety.However,the mathematic scoring systems in use are not appropriate to use for determining strategy for spinal metastasis management.The present individualized and flexible strategy,which not only takes advantage of the surgeries but also emphasizes the effects of the adjunctive therapies,is more scientific and reasonable so good surgical outcomes can be achieved if this plan is used.更多还原