后路显微镜辅助硬膜内病变切除联合脊柱内固定术治疗硬膜内转移癌疗效分析
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摘要
目的:探讨后路显微镜辅助硬膜内病变切除联合脊柱内固定术治疗硬膜内转移癌的手术效果。方法:回顾性分析我院骨科2011年1月～2016年1月收治的随访资料完整的硬膜内转移癌患者10例。所有患者均采用后路显微镜辅助硬膜内病变切除联合脊柱内固定术。其中男性6例,女性4例,年龄44～63岁,中位年龄为55岁,原发肿瘤包括肺癌3例,乳腺癌3例,肾癌2例,舌癌和食管癌各1例,肿瘤位于颈椎管内1例,胸椎管内4例,胸腰段2例,腰椎管内3例。硬膜内髓外转移8例,硬膜内髓内转移2例。记录患者的手术时间、术中出血量、术后并发症发生率、生存时间。以视觉模拟评分(visual analogue scale,VAS)、椎管内肿瘤McCormick分级及功能状态(karnofsky performance score,KPS)评分分别对患者的术前、术后1个月的转移灶引起的疼痛、术后3个月神经及整体情况进行评估。结果:10例椎管内硬膜下转移癌患者的手术时间为130～260min(180.0±25.4min),术中出血量400～2100ml(1050.0±350.4)ml,术后的生存时间10～19个月(中位生存时间为11个月)。所有患者术后疼痛均有明显的缓解,术后1个月VAS疼痛评分从术前的6.70±0.67分降至1.70±0.67分(P<0.05)。术后3个月KPS评分从术前的42.00±4.21分提升至术后的69.00±7.37分(P<0.05)。术后3个月McCormick分级9例较术前明显的提升,1例3级患者术后无明显改善,无术后神经症状恶化的病例。术后并发症2例(脑脊液漏1例,术后血肿1例),均为髓内转移患者,分别经保守及二次手术后好转。结论:后路显微镜辅助硬膜内病变切除联合脊柱内固定术治疗硬膜内转移癌,可以提高患者的生活质量,但对于脊髓内转移患者手术应谨慎施行。
Objectives: To investigate the effects of posterior microscope-assisted dural resection combined with spinal internal fixation in the treatment of single-center intradural spinal cord metastases(ISCM). Methods: Retrospective analysis was conducted in 10 patients with ISCM treated with surgery from orthopedic department of the Fourth Hospital of Hebei Medical University from January 2011 to January 2016. There were10 patients in this cohort, including 6 males and 4 females, aged from 44 to 63 years. The median age was55 years. Primary tumors included 3 lung cancer, 3 breast cancer, 2 kidney cancer, 1 tongue cancer and 1 esophageal cancer. The tumor was located in the cervical spinal canal in 1 case, 4 cases of thoracic canal, 2 cases of thoracolumbar canal, 3 cases of lumbar spinal cord, 8 cases of extramedullary metastases, 2 cases of intramedullary metastases. The data included operation time, intraoperative blood loss, complications and survival time. The visual analogue scale(VAS), McCormick score and KPS score were used to evaluate the pain,neurological function and survival status of the patients before and after operation. Results: The operation time was 130-260 min(180 ±25.4 min), the intraoperative blood loss was 400-2100 ml(1050 ±350.4 ml), and the median survival time was 10-19 months(median survival time was 11 months). All patients had significantly relieved postoperative pain, the VAS pain score at 1 month after operation decreased from 6.70±0.67 points to 1.70±0.67 points(P<0.05). The KPS score significantly improved from preoperative 42.00 ±4.21 points to69.00±7.37 points at 3 months after operation(P<0.05). 9 cases had significantly improved McCormick score at3 months after operation compared with preoperation. 1 case of grade 3 had no significant improvement after surgery, and there was no postoperative neurological symptom deteriorated case. As for postoperative complications, one was the cerebrospinal fluid leakage, the other was the hematoma. Both of them were the intramedullary metastases. Conclusions: Posterior microscope-assisted dural resection combined with spinal internal fixation can improve the life quality of patients with intradural spinal cord metastases, whereas caution is advised for intramedullary lesions.
Objectives: To investigate the effects of posterior microscope-assisted dural resection combined with spinal internal fixation in the treatment of single-center intradural spinal cord metastases(ISCM). Methods: Retrospective analysis was conducted in 10 patients with ISCM treated with surgery from orthopedic department of the Fourth Hospital of Hebei Medical University from January 2011 to January 2016. There were10 patients in this cohort, including 6 males and 4 females, aged from 44 to 63 years. The median age was55 years. Primary tumors included 3 lung cancer, 3 breast cancer, 2 kidney cancer, 1 tongue cancer and 1 esophageal cancer. The tumor was located in the cervical spinal canal in 1 case, 4 cases of thoracic canal, 2 cases of thoracolumbar canal, 3 cases of lumbar spinal cord, 8 cases of extramedullary metastases, 2 cases of intramedullary metastases. The data included operation time, intraoperative blood loss, complications and survival time. The visual analogue scale(VAS), McCormick score and KPS score were used to evaluate the pain,neurological function and survival status of the patients before and after operation. Results: The operation time was 130-260 min(180 ±25.4 min), the intraoperative blood loss was 400-2100 ml(1050 ±350.4 ml), and the median survival time was 10-19 months(median survival time was 11 months). All patients had significantly relieved postoperative pain, the VAS pain score at 1 month after operation decreased from 6.70±0.67 points to 1.70±0.67 points(P<0.05). The KPS score significantly improved from preoperative 42.00 ±4.21 points to69.00±7.37 points at 3 months after operation(P<0.05). 9 cases had significantly improved McCormick score at3 months after operation compared with preoperation. 1 case of grade 3 had no significant improvement after surgery, and there was no postoperative neurological symptom deteriorated case. As for postoperative complications, one was the cerebrospinal fluid leakage, the other was the hematoma. Both of them were the intramedullary metastases. Conclusions: Posterior microscope-assisted dural resection combined with spinal internal fixation can improve the life quality of patients with intradural spinal cord metastases, whereas caution is advised for intramedullary lesions.
引文
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9 . Fabi A, Felici A, Metro G, et al. Brain metastases from solid tumors:disease outcome according to type of treatment and therapeutic resources of the treating center[J]. J Exp Clin Cancer Res, 2011, 30:10. doi:10.1186/1756-9966-30-10.
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11 . Ji GY, Oh CH, Kim SH, et al. Intradural cauda equina metastasis of renal cell carcinoma:a case report with literature review of 10 cases[J]. Spine(Phila Pa 1976), 2013, 38(18):E1171-1174.
12 . Rades D, Schiff D. Epidural and intramedullary spinal metastasis:clinical features and role of fractionated radiotherapy[J]. Handb Clin Neurol, 2018, 149:227-238.
13 . Hoover JM, Krauss WE, Lanzino G. Intradural spinal metastases:a surgical series of 15 patients[J]. Acta Neurochir(Wien), 2012, 154(5):871-877.
14 . Wostrack M, Pape H, Kreutzer J, et al. Surgical treatment of spinal intradural carcinoma metastases[J]. Acta Neurochir(Wien), 2012, 154(2):349-357.
15 .邱勇,刘兴勇.神经电生理监测在脊柱外科的应用现状[J].中国脊柱脊髓杂志, 2015, 25(7):670-672.
16 . Xu Y, Zhong W, Chen M, et al. ALK-rearranged lung cancer with intradural extramedullary spinal cord metastases responding to ceritinib treatment:a case report[J]. Thorac Cancer, 2018, 9(8):1078-1081.
2 . Costigan DA, Winkelman MD. Intramedullary spinal cord metastasis. A clinicopathological study of 13 cases[J]. J Neurosurg, 1985, 62(2):227-233.
3 . Frey I, LeBreton C, Lefkopoulos A, et al. Intradural extramedullary spinal canal secondary neoplasms:MR findings in 30 patients[J]. Eur Radiol, 1998, 8(7):1187-1192.
4 . Mintz AP, Cairncross JG. Treatment of a single brain metastasis:the role of radiation following surgical resection[J]. JAMA,1998, 280(17):1527-1529.
5 . Kienast Y, von Baumgarten L, Fuhrmann M, et al. Real-time imaging reveals the single steps of brain metastasis formation[J]. Nat Med, 2010, 16(1):116-122.
6 . Kalayci M, Cagavi F, Gül S, et al. Intramedullary spinal cord metastases:diagnosis and treatment-an illustrated review[J].Acta Neurochir, 2004, 146(12):1347-1354.
7 . Suki D, Abouassi H, Patel AJ, et al. Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa[J]. J Neurosurg, 2008, 108(2):248-257.
8 . Dam-Hieu P, Seizeur R, Mineo JF, et al. Retrospective study of 19 patients with intramedullary spinal cord metastasis[J].Clin Neurol Neurosurg, 2009, 111(1):10-17.
9 . Fabi A, Felici A, Metro G, et al. Brain metastases from solid tumors:disease outcome according to type of treatment and therapeutic resources of the treating center[J]. J Exp Clin Cancer Res, 2011, 30:10. doi:10.1186/1756-9966-30-10.
10 . Payer S, Mende KC, Westphal M, et al. Intramedullary spinal cord metastases:an increasingly common diagnosis[J].Neurosurg Focus, 2015, 39(2):E15. doi:10.3171/2015.5.FOCUS15149.
11 . Ji GY, Oh CH, Kim SH, et al. Intradural cauda equina metastasis of renal cell carcinoma:a case report with literature review of 10 cases[J]. Spine(Phila Pa 1976), 2013, 38(18):E1171-1174.
12 . Rades D, Schiff D. Epidural and intramedullary spinal metastasis:clinical features and role of fractionated radiotherapy[J]. Handb Clin Neurol, 2018, 149:227-238.
13 . Hoover JM, Krauss WE, Lanzino G. Intradural spinal metastases:a surgical series of 15 patients[J]. Acta Neurochir(Wien), 2012, 154(5):871-877.
14 . Wostrack M, Pape H, Kreutzer J, et al. Surgical treatment of spinal intradural carcinoma metastases[J]. Acta Neurochir(Wien), 2012, 154(2):349-357.
15 .邱勇,刘兴勇.神经电生理监测在脊柱外科的应用现状[J].中国脊柱脊髓杂志, 2015, 25(7):670-672.
16 . Xu Y, Zhong W, Chen M, et al. ALK-rearranged lung cancer with intradural extramedullary spinal cord metastases responding to ceritinib treatment:a case report[J]. Thorac Cancer, 2018, 9(8):1078-1081.