脊柱转移瘤481例的流行病学分析

发布时间：2018-05-31 15:55

本文选题：脊柱转移瘤 + 回顾性分析　；参考：《中国脊柱脊髓杂志》2017年09期

【摘要】：目的 :总结分析脊柱转移瘤的发病特点和临床特征。方法 :对国内3家医院(天津医院、河北医科大学附属第三医院、济南军区总医院)2007年1月~2016年12月所有脊柱转移瘤患者的人口学特征、原发灶来源、侵犯部位、临床症状及治疗方法进行回顾性分析。纳入标准:经临床、影像和病理检查确诊为脊柱转移瘤且医疗资料收录完整。排除标准:仅有临床、影像证据,无明确病理诊断者;不能明确排除脊柱原发肿瘤、结核、退行性病变可能的病例。对复发病例按单例计算。结果:481例脊柱转移瘤患者符合纳入标准,其中男287例(59.7%),女194例(40.3%);发病年龄18~86岁,中位年龄60.0岁,以50~69岁为高发年龄,平均59.2±11.1岁,男性平均发病年龄59.6±11.5岁,女性平均发病年龄58.5±10.5岁,差异无统计学意义(t=0.277,P0.05)。原发肿瘤为肺癌181例,肾癌40例,女性乳腺癌29例,肝癌25例,胃肠肿瘤23例,前列腺癌20例,甲状腺癌、食管癌等肿瘤病例数均小于20例(共70例),来源不明的肿瘤93例;单纯侵及颈椎37例,胸椎135例,腰椎130例,骶椎42例,跨节段(同时累及颈、胸、腰、骶两个及以上节段)的患者137例;就诊时,出现脊髓受压症状及脊柱转移部位局部疼痛的患者281例,单纯脊柱转移部位疼痛128例,只有脊髓受压症状33例,无转移部位症状而在体检中发现脊柱转移39例;有原发肿瘤病史者75例。手术治疗314例,其中266例行开放性手术,48例行经皮椎体成形术(PVP)或经皮球囊扩张椎体成形术(PKP);保守治疗167例,应用磷酸盐等抗骨质破坏药物、放射性核素治疗、放疗及止痛、全身营养支持等对症治疗。结论:脊柱转移瘤患者中男性多于女性,发病高峰为50~69岁。患者多因脊柱转移病变所致症状就诊,有明确原发肿瘤病史者较少。原发灶多为上皮或腺体来源的脏器肿瘤,尤以肺癌多见,间叶组织来源的肿瘤较少。常见侵袭部位为胸椎、腰椎,临床上以缓解症状、延缓病情发展等姑息性治疗方法为主。
[Abstract]:Objective: to summarize and analyze the incidence and clinical features of spinal metastases. Methods: the demographic characteristics, origin and location of spinal metastases in 3 hospitals (Tianjin Hospital, third affiliated Hospital of Hebei Medical University, General Hospital of Jinan military region) from January 2007 to December 2016 were analyzed. The clinical symptoms and treatment methods were analyzed retrospectively. Inclusion criteria: confirmed spinal metastases by clinical, imaging and pathological examination and complete medical data. Exclusion criteria: only clinical, imaging evidence, no clear pathological diagnosis; can not clearly exclude primary spinal tumors, tuberculosis, degenerative lesions of possible cases. The recurrence cases were calculated as a single case. Results among the 481 patients with spinal metastases, 287 were male (59.7m) and 194 were female (40.3). The age of onset was 1886 years old with a median age of 60.0 years, with a mean age of 59.2 卤11.1 years (mean 59.2 卤11.1 years) and an average age of 59.6 卤11.5 years (male). The average onset age of female was 58.5 卤10.5 years old, and there was no significant difference between them. There were 181 cases of primary tumor, 40 cases of renal carcinoma, 29 cases of female breast cancer, 25 cases of liver cancer, 23 cases of gastrointestinal tumor, 20 cases of prostate cancer, less than 20 cases of thyroid cancer and esophageal carcinoma. There were 37 cases of cervical vertebrae, 135 cases of thoracic vertebra, 130 cases of lumbar vertebra, 42 cases of sacral vertebra, 137 cases of intersegmental involvement of cervical, thoracic, lumbar and sacral segments. 281 cases of spinal cord compression and local pain of spinal metastases, 128 cases of simple spinal metastasis pain, 33 cases of spinal cord compression symptoms, 39 cases of spinal metastases were found in physical examination. 75 cases had a history of primary tumor disease. Surgical treatment was performed in 314 cases, of which 266 cases were treated with open vertebroplasty or 48 cases with percutaneous vertebroplasty or percutaneous balloon vertebroplasty, 167 cases with conservative treatment were treated with phosphate, radionuclide therapy, radiotherapy and pain relief. General nutritional support and other symptomatic treatment. Conclusion: there are more males than females in patients with spinal metastases, with a peak incidence of 50 to 69 years old. Most of the patients were diagnosed with spinal metastases, and few had a clear history of primary oncology. Most of the primary tumors were epithelial or glandular tumors, especially lung cancer, but the mesenchymal tissues were less. The common invasive sites were thoracic vertebrae and lumbar vertebrae, and palliative treatment methods such as relieving symptoms and delaying the development of disease were the main clinical methods.
【作者单位】：天津医科大学研究生院;山东省潍坊市人民医院脊柱科;天津市天津医院骨肿瘤科;济南军区总医院骨病科;河北医科大学附属第三医院骨肿瘤科;
【基金】：天津市卫生局课题(编号:15KG124)
【分类号】：R738.1

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