2018 , Vol. 04 >Issue 01: 14 - 19
DOI: https://doi.org/10.3877/cma.j.issn.2096-0263.2018.01.004
肺癌脊柱转移瘤的手术疗效分析
收稿日期: 2016-12-08
网络出版日期: 2018-02-05
The curative effect of surgical treatment for spinal metastases of lung cancer
Received date: 2016-12-08
Online published: 2018-02-05
探讨肺癌脊柱转移瘤的手术治疗效果。
回顾性分析2012年1月至2016年5月在浙江大学附属第二医院骨肿瘤中心及浙江省嘉兴市第二医院骨科住院治疗且病理诊断明确的肺癌脊柱转移瘤患者72例。其中男性48例（66.7%），女性24例（33.3%），平均年龄（61±4）岁，39例（54.2%）术前生存期评分为6分，27例（37.5%）7分，6例（8.3%）8分。随访并比较患者手术前后疼痛视觉模拟评分（VAS）及Frankel分级变化情况，评价手术疗效。
65例患者获得满意随访（90.2%）。随访时间6~12个月，平均（8.5±1.6）个月，VAS评分由术前（5.9±1.1）分降至术后（2.7±1.2）分，差异有统计学意义（t=21.24，P<0.05）。术后Frankel分级明显改善，差异有统计学意义（Z=-4.978，P<0.05），42例术前有神经功能障碍者5例未恢复，37例部分恢复，差异有统计学意义（Z=-4.978，P<0.05）。
手术治疗肺癌脊柱转移瘤可有效缓解患者疼痛程度，改善神经功能。
陆惠根 , 黄鑫 , 张中伟 , 叶招明 . 肺癌脊柱转移瘤的手术疗效分析[J]. 中华老年骨科与康复电子杂志, 2018 , 04(01) : 14 -19 . DOI: 10.3877/cma.j.issn.2096-0263.2018.01.004
To investigate the curative effect of surgical treatment for spinal metastases of lung cancer.
A retrospective study was performed in 72 cases of spinal metastases of lung cancer treated in The Second Affiliated Hospital of Zhejiang University and The Second Hospital of Jiaxing. There were 48 males (66.7%) and 24 females (33.3%) with an average age of 61±4 years. The preoperative survival score were evaluated and 39 cases (54.2%) were 6 points, 27 cases (37.5%) were 7 points and 6 cases (8.3%) were 8 points. The Visual Analogue Scale (VAS) score and Frankel classification of two group were compared before and after surgery.
Sixty-five patients (90.2%) were followed-up with a timespan of 6-12 months (8.5±1.6 months on the average). The VAS score decreased to (2.7±1.2) from preoperatively (5.9±1.1), with statisticl significance (t=21.24, P<0.05). The postoperative Frankel score was significantly improved, with statisticl significance (Z=-4.978, P<0.05). 5 patients among 42 cases with neurological deficit were not improved, 37 cases were partially recovered (Z=-4.978, P<0.05).
Surgical treatment can relieve the pain and improve the neurological function of patients with spinal metastases of lung cancer.
Key words： Spine; Lung neoplasms; Neoplasma metastasis; Surgal procedures, operative
| 1 | 蒋堪秋, 钱永跃, 陈勇兵, 等. 外科手术治疗老年非小细胞肺癌患者预后的影响因素分析[J]. 中华老年医学杂志, 2016, 35(3): 260-262. |
| 2 | Sandler A, Gray R, Perry MC, et al. Paclitaxel–carboplatin alone or with bevacizumab for Non–Small-Cell lung cancer [J]. N Engl J Med, 2006, 355(24): 2542-2550. |
| 3 | Schild SE, Stella PJ, Geyer SM, et al. The outcome of combined-modality therapy for stage Ⅲ non-small-cell lung cancer in the elderly[J]. J Clin Oncol, 2003, 21(17): 3201-3206. |
| 4 | 王文娴, 郑蕾, 宋正波, 等. 埃克替尼治疗老年晚期非小细胞肺癌患者的疗效和安全性[J]. 中华老年医学杂志, 2015, 34(11): 1247-1249. |
| 5 | Maemondo M, Minegishi Y, Inoue A, et al. First-line gefitinib in patients aged 75 or older with advanced non-small cell lung cancer harboring epidermal growth factor receptor mutations: NEJ 003 study [J]. J Thorac Oncol, 2012, 7(9): 1417-1422. |
| 6 | 杨祚璋, 孙宇庆, 施建党, 等. 骨转移癌的诊断与治疗[M]. 昆明: 云南科技出版社, 2012: 91. |
| 7 | Wu YL, Chu DT, Han B, et al. Phase Ⅲ, randomized, open-label, first-line study in Asia of gefitinib versus carboplatin/paclitaxel in clinically selected patients with advanced non-small-cell lung cancer: evaluation of patients recruited from mainland China [J]. Asia Pac J Clin Oncol, 2012, 8(3): 232-243. |
| 8 | 欧阳伟炜, 周华宁, 舒胜发, 等. 放疗及唑来膦酸治疗对肺癌癌性骨痛患者生活质量影响的初步探讨[J]. 中国疼痛医学杂志, 2010, 16(3): 183-184. |
| 9 | Choi D, Crockard A, Bunger C, et al. Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group [J]. Eur Spine J, 2010, 19(2): 215-222. |
| 10 | Harrington KD. The use of methylmethacrylate for vertebral-body replacement and anterior stabilization of pathological fracture-dislocations of the spine due to metastatic malignant disease [J]. J Bone Joint Surg Am, 1981, 63(1): 36-46. |
| 11 | Tokuhashi Y, Matsuzaki H, Toriyama S, et al. Scoring system for the preoperative evaluation of metastatic spine tumor prognosis [J]. Spine (Phila Pa 1976), 1990, 15(11): 1110-1113. |
| 12 | 赵杰. 脊柱转移性肿瘤的诊疗原则[J]. 中国脊柱脊髓杂志, 2011, 07(7): 533-534. |
| 13 | Tokuhashi Y, Matsuzaki H, Oda H, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis [J]. Spine (Phila Pa 1976), 2005, 30(19): 2186-2191. |
| 14 | Teixeira WG, Coutinho PR, Marchese LD, et al. Interobserver agreement for the spine instability neoplastic score varies according to the experience of the evaluator [J]. Clinics, 2013, 68(2): 213-218. |
| 15 | Tomita K, Kawahara N, Kobayashi T, et al. Surgical strategy for spinal metastases [J]. Spine (Phila Pa 1976), 2001, 26(3): 298-306. |
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