病灶内边界整块切除对于恶性和局部侵袭性脊椎肿瘤的意义

发布时间：2018-03-13 08:36

本文选题：脊椎　切入点：肿瘤　出处：《中国脊柱脊髓杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的:对比病灶内边界整块切除与分块切刮治疗恶性或局部侵袭性脊椎肿瘤患者的预后,评估肿瘤不同切除方式对临床疗效的影响。方法:2007年6月~2015年12月47例计划进行整块切除的脊柱原发性肿瘤或孤立性转移瘤患者(获得病灶内边界),按照肿瘤切除方式分为整块切除和分块切刮两组。其中32例患者进入整块切除组,15例未能完成肿瘤整块切除的患者进入分块切刮组。对两组患者的年龄、性别、肿瘤恶性程度、累及部位、手术入路、是否全脊椎切除、随访时间、术中出血量、手术时间、肿瘤局部复发、生存情况、并发症情况进行统计比较。结果:两组患者在平均年龄、性别、肿瘤恶性程度、累及节段、手术入路、是否全脊椎切除、术后神经功能改善、随访时间等方面无显著性差异(P0.05)。平均手术时间整块切除组424.53±236.93min,分块切刮组306.67±90.92min(P0.05);平均术中出血量整块切除组4043.75±2305.80ml,分块切刮组3680.00±3163.23ml(P0.05)。整块切除组和分块切刮组中,分别有11例(34.4%)和3例(20%)患者出现并发症(P0.05)。整块切除组肿瘤局部复发12例(37.5%),随访期内17例无瘤生存,8例带瘤生存,7例因肿瘤死亡;分块切刮组肿瘤局部复发9例(60%),无瘤生存,带瘤生存,因肿瘤死亡各5例。两组在肿瘤局部无复发生存率及总体生存率上存在显著差异(P0.05)。结论:对脊柱恶性或侵袭性肿瘤进行整块切除,即使获得病灶内边界,较分块切刮仍具有较好的局部控制和生存率,但具有较高的并发症发生率。
[Abstract]:Objective: to compare the prognosis of patients with malignant or local invasive spinal tumors treated by intralesional and segmental curettage. Methods: from June 2007 to December 2015, 47 patients with primary spinal tumor or solitary metastases scheduled to be resected with a single piece of spinal column were evaluated. Methods: from June 2007 to December 2015, 47 patients with primary spinal tumors or solitary metastases were treated by resection according to the tumor. Among them, 32 patients entered the whole resection group and 15 patients who failed to complete the whole tumor resection entered the curettage group. For the age of the two groups, Sex, tumor malignancy, site of involvement, operative approach, total spinal resection, follow-up time, intraoperative bleeding, operative time, local recurrence of tumor, survival, Results: the mean age, sex, tumor malignancy, involvement segment, operative approach, total spinal resection, postoperative neurological function were improved in the two groups. The mean operative time was 424.53 卤236.93 min in the whole resection group, 306.67 卤90.92 min in the curettage group, 4043.75 卤2305.80 ml in the whole block curettage group and 3680.00 卤3163.23 ml / P 0.05 in the block curettage group. In the whole resection group, there were 12 cases of tumor recurrence in 12 cases and 37.5%. During the follow-up period, 17 cases survived without tumor, 8 cases survived with tumor and 7 cases died because of the tumor, while in the group of curettage and curettage, 9 cases had local recurrence, 9 cases had local recurrence, and 9 cases had tumor free survival. There were significant differences in local recurrence survival rate and overall survival rate between the two groups (P 0.05). Conclusion: complete resection of malignant or invasive spinal tumors is possible, even if the internal boundaries of the lesions are obtained. The local control and survival rate of curettage was better than that of curettage, but the incidence of complications was higher.
【作者单位】：北京大学人民医院骨与软组织肿瘤诊疗中心;
【分类号】：R738.1

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