论文部分内容阅读
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,P>0.05)。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。
Objective: To summarize and analyze the characteristics and clinical features of spinal metastases. Methods: The demographic characteristics, source of primary tumor and infiltration of all patients with spinal metastases from January 2007 to December 2016 in three hospitals in China (Tianjin Hospital, Third Affiliated Hospital of Hebei Medical University, Jinan Military Region General Hospital) , Clinical symptoms and treatment of retrospective analysis. Inclusion criteria: clinical, imaging and pathological examination diagnosed as spinal metastases and medical data included complete. Exclusion criteria: only clinical, imaging evidence, no clear pathological diagnosis; can not be clearly ruled out the primary spine tumors, tuberculosis, degenerative diseases possible cases. The recurrence of cases by a single case calculation. Results: 481 patients with spinal metastases met the inclusion criteria, including 287 males (59.7%) and 194 females (40.3%). The age of onset was 18-86 years old, with a median age of 60.0 years and a high incidence of age of 50-69 years (Average 59.2 ± 11.1 years). The mean age of onset was 59.6 ± 11.5 years in males and 58.5 ± 10.5 years in females. The difference was not statistically significant (t = 0.277, P> 0.05). Primary tumors were 181 cases of lung cancer, 40 cases of renal cell carcinoma, 29 cases of female breast cancer, 25 cases of liver cancer, 23 cases of gastrointestinal cancer, 20 cases of prostate cancer, and less than 20 cases of thyroid cancer and esophageal cancer (93 cases with unknown origin), 37 cases with cervical spondylosis, 135 cases with thoracic spine, 130 cases with lumbar spine, 42 cases with sacral vertebrae and multiple segments (involving two or more segments of the neck, chest, waist and sacral) Of the 137 patients; at the time of treatment, there were 281 patients with spinal cord compression symptoms and local pain in the spine, 128 patients with simple spine metastasis, only spinal cord compression symptoms in 33 cases, no metastatic site symptoms found in the physical examination of the spine 39 cases of metastasis; 75 cases of primary tumor history. Surgical treatment of 314 cases, of which 266 were open surgery, 48 cases of percutaneous vertebroplasty (PVP) or percutaneous balloon angioplasty (PKP); conservative treatment of 167 cases, the use of phosphate and other anti-bone Quality destruction drugs, radionuclide therapy, radiotherapy and analgesics, systemic nutrition support symptomatic treatment. Conclusions: There are more males than females in patients with spinal metastases. The peak incidence is 50 to 69 years old. Mostly due to symptoms of spinal metastases due to treatment, there is a clear history of primary tumor less. Primary tumors are mostly epithelial or glandular origin organ tumors, especially lung cancer more common, mesenchymal origin of the tumor less. Common invasion sites for the thoracic and lumbar, clinically to relieve symptoms, delay the progression of palliative treatment.