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目的:对比病灶内边界整块切除与分块切刮治疗恶性或局部侵袭性脊椎肿瘤患者的预后,评估肿瘤不同切除方式对临床疗效的影响。方法:2007年6月~2015年12月47例计划进行整块切除的脊柱原发性肿瘤或孤立性转移瘤患者(获得病灶内边界),按照肿瘤切除方式分为整块切除和分块切刮两组。其中32例患者进入整块切除组,15例未能完成肿瘤整块切除的患者进入分块切刮组。对两组患者的年龄、性别、肿瘤恶性程度、累及部位、手术入路、是否全脊椎切除、随访时间、术中出血量、手术时间、肿瘤局部复发、生存情况、并发症情况进行统计比较。结果:两组患者在平均年龄、性别、肿瘤恶性程度、累及节段、手术入路、是否全脊椎切除、术后神经功能改善、随访时间等方面无显著性差异(P>0.05)。平均手术时间整块切除组424.53±236.93min,分块切刮组306.67±90.92min(P<0.05);平均术中出血量整块切除组4043.75±2305.80ml,分块切刮组3680.00±3163.23ml(P<0.05)。整块切除组和分块切刮组中,分别有11例(34.4%)和3例(20%)患者出现并发症(P<0.05)。整块切除组肿瘤局部复发12例(37.5%),随访期内17例无瘤生存,8例带瘤生存,7例因肿瘤死亡;分块切刮组肿瘤局部复发9例(60%),无瘤生存,带瘤生存,因肿瘤死亡各5例。两组在肿瘤局部无复发生存率及总体生存率上存在显著差异(P<0.05)。结论:对脊柱恶性或侵袭性肿瘤进行整块切除,即使获得病灶内边界,较分块切刮仍具有较好的局部控制和生存率,但具有较高的并发症发生率。
OBJECTIVE: To compare the prognosis of patients with malignant or locally aggressive vertebral tumors treated with en bloc resection and segmental incision to assess the effect of different resection modalities on clinical outcome. METHODS: From June 2007 to December 2015, 47 patients with primary or isolated spondylolisthesis who underwent resection of the entire mass (internal borders of lesions) were enrolled in this study. According to the tumor resection methods, they were divided into two groups: Shaving two groups. Among them, 32 patients entered the whole resection group and 15 patients who failed to complete the tumor resection entered the sub-scalpel group. The age, gender, tumor malignancy, involved sites, surgical approach, total splenectomy, follow-up time, intraoperative blood loss, operation time, local recurrence, survival and complications of two groups were compared statistically. Results: There was no significant difference between the two groups in terms of average age, sex, degree of tumor malignancy, involved segments, surgical approach, total splenectomy, postoperative neurological function improvement, follow-up time and so on (P> 0.05). The average operative time was 424.53 ± 236.93min in the resection group and 306.67 ± 90.92min in the subcuticle scraping group (P <0.05). The mean operative blood loss was 4043.75 ± 2305.80ml in the resection group, 3680.00 ± 3163.23ml in the subcuticle scraping group (P <0.05). Eleven patients (34.4%) and three patients (20%) had complications (P <0.05) in the resection group and the partial scrape group, respectively. There were 12 cases (37.5%) with local recurrence in the resection group, 17 cases survived in the follow-up period, 8 cases survived in the tumor and 7 died in the tumor. Nine cases (60% Tumor-free survival, with tumor survival, due to tumor death in 5 cases. There was a significant difference between the two groups in the local recurrence-free survival and overall survival (P <0.05). CONCLUSIONS: Block resection of a malignant or aggressive tumor of the spine has better local control and survival than sub-block scoring even with intra-lesion boundaries, but with a high complication rate.