脊柱非何杰金淋巴瘤的治疗方法选择及评价

发布时间：2018-04-30 20:04

本文选题：脊柱非何杰金淋巴瘤 + 治疗　；参考：《中国脊柱脊髓杂志》2017年04期

【摘要】：目的 :探讨脊柱非何杰金淋巴瘤的治疗方法选择及疗效。方法 :2006年6月~2012年11月我院骨科收治并获随访的脊柱非何杰金淋巴瘤患者15例,男8例,女7例,年龄42±18岁(16~71岁)。局部疼痛14例。神经功能损害11例,其中脊髓损害5例,Frankel C级3例,D级2例;马尾损害6例。11例患者行CT引导下穿刺活检,8例确诊为淋巴瘤,1例误诊为Langerhans细胞增多症,2例仅诊断为"小细胞恶性肿瘤",其余患者经术后病理检查确诊。15例患者中,5例未接受手术治疗,其中4例不伴严重神经损害及节段不稳定患者,经穿刺活检确诊后,首选化疗,均未接受进一步放疗;1例患者为马尾综合征,无法耐受手术,行急诊放疗,后行化疗。10例接受手术治疗,其中7例患者因神经功能损害合并节段不稳定行手术治疗,术后1例患者未接受进一步治疗,4例患者接受化疗及放疗,2例患者接受单纯化疗;1例患者行穿刺活检未能确诊,因节段不稳定行手术,病理检查确诊后接受化疗;2例患者伴病理性骨折,行经皮穿刺椎体成形术(percutaneous vertebroplasty,PVP),术后1例行化疗,1例行化疗+放疗。手术患者术前Karnofsky日常状态评分(Karnofsky performance score,KPS)为47±18分,疼痛视觉模拟评分(visual analog score,VAS)评分为7.7±1.0分;非手术患者治疗前KPS为62±18分,VAS评分6.4±1.0分。结果:15例随访时间为52±34个月(3~108个月),其中5例死亡(分别存活3、10、10、15、25个月)。局部疼痛患者经治疗后症状均有缓解,其中3例完全缓解。11例神经损害者,3例保守治疗,8例手术,手术患者中脊髓损伤4例,末次随访Frankel分级至少改善1级,其中2例完全恢复,所有马尾损伤患者均明显恢复。手术患者末次随访时VAS评分为1.4±1.0分,较术前明显降低(P0.05);末次随访时KPS评分为91±15分,较术前有显著提高(P0.05)。非手术治疗患者5例,4例存活,末次随访时VAS为1.0±0.6分,KPS为76±10分,与治疗前比较均有统计学差异(P0.05)。所有患者预期5年生存率为66.7%,其中手术患者为60%,非手术患者为80%。结论:对于脊柱非何杰金淋巴瘤,化疗及放疗为最主要的治疗手段;对于神经损伤重、结构不稳定的患者,手术治疗可有效解除脊髓压迫、改善神经功能及稳定结构,提高生活质量。
[Abstract]:Objective: to investigate the choice of treatment and curative effect of spinal non-Hodgkin's lymphoma. Methods: from June 2006 to November 2012, 15 patients with spinal non-Hodgkin 's lymphoma, 8 males and 7 females, aged 42 卤18 years or 1671 years, were treated in our orthopedic department and followed up. Local pain was found in 14 cases. There were 11 cases of neurological impairment, of which 5 cases had spinal cord injury, 3 cases had grade C of Frankel C and 2 cases had grade D; CT-guided biopsy was performed in 6, 11 patients with cauda equina lesion. One case was misdiagnosed as Langerhans cell hyperplasia in 1 case, 2 cases were only diagnosed as "small cell malignant tumor", and 15 cases were diagnosed by pathological examination after operation. 5 cases were not treated by operation. Among them, 4 cases without serious nerve damage and segmental instability, after confirmed by puncture biopsy, the first choice of chemotherapy, none of them received further radiotherapy, one case was cauda equina syndrome, which could not tolerate surgery, and was treated with emergency radiotherapy. After chemotherapy, 10 patients received surgical treatment, 7 of them underwent surgical treatment because of neurological dysfunction and segmental instability. One patient received no further treatment, 4 patients received chemotherapy and 2 patients received chemotherapy alone. One patient underwent puncture biopsy and was operated on because of segmental instability. Two patients with pathological fracture were treated with chemotherapy after pathological examination. Percutaneous vertebroplasty and percutaneous vertebroplastic PVP were performed. One patient received chemotherapy and one received radiotherapy. The preoperative Karnofsky daily state score and visual analog score were 47 卤18, 7.7 卤1.0, 62 卤18 and 6.4 卤1.0, respectively. Results the follow-up time of 15 cases was 52 卤34 months or 3 ~ 108 months, of which 5 cases died. The symptoms of patients with local pain were all relieved after treatment. Among them, 3 cases were completely relieved. 3 cases of nerve damage were treated conservatively in 8 cases of operation. 4 cases of spinal cord injury were operated on. The Frankel grade was improved at least 1 grade at the last follow-up. Two of them recovered completely, and all the patients with cauda equina injury recovered obviously. The VAS score at the last follow-up was 1.4 卤1.0, which was significantly lower than that before operation (P 0.05), and the KPS score at the last follow-up was 91 卤15, which was significantly higher than that before operation. Five patients with non-operative treatment survived, and the VAS at the last follow-up was 1. 0 卤0. 6 and 76 卤10. There was a significant difference compared with that before treatment (P 0. 05). The 5-year survival rate was expected to be 66. 7% for all patients, 60 for surgical patients and 80 for non-operative patients. Conclusion: for spinal non-Hodgkin 's lymphoma, chemotherapy and radiotherapy are the main treatment methods, and for patients with severe nerve injury and unstable structure, surgical treatment can effectively relieve spinal cord compression, improve nerve function and stable structure. Improve the quality of life.
【作者单位】：北京大学第三医院骨科;
【分类号】：R738

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