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背景:肿瘤脊柱转移常并发疼痛、活动受限及瘫痪,预后差。目的:探讨影响脊柱转移癌脊髓功能恢复的因素及其治疗方法,以期提高晚期癌症患者的生活质量。设计:病例自身对照观察。单位:广东医学院附属医院肿瘤科和放疗科。对象:选择1992-03/2001-06广东医学院附属医院肿瘤科收治的伴有不同程度瘫痪症状的脊柱转移癌患者162例,均自愿参加观察。方法:①放疗及化疗:所有患者均采用对症治疗并行单纯放射治疗或放疗与化疗综合治疗,其中放疗剂量为2Gy/次,5次/周,共进行3周;化疗根据不同原发肿瘤制定联合方案,化疗2～6个周期,平均3个周期,每个周期21d。②康复疗法包括运动疗法、按摩(2次/d)、功能性电刺激(1次/d)、排尿训练及排便训练(每天一两次),10d为1个疗程,连续3个疗程。治疗结束后观察止痛效果、肢体肌力及排便功能恢复情况。主要观察指标:治疗结束后患者疼痛缓解情况及肢体肌力、排便功能恢复情况。结果:162例患者全部进入结果分析,无脱落。①疼痛完全缓解97例(59.88%);无缓解0例。②肌力明显改善127例(78.40%),无改善35例(21.60%)。单发病灶及相邻2个椎体病灶患者,其肌力好转率为92.98%;多发病灶肌力好转率为64.59%。病史<2周的患者,治疗后肌力明显进步,>2个月的患者肌力无改善。21例患者治疗前CT或MRI显示病变段脊髓严重受压,治疗后仅2例肌力进步,其余无改善。③162例患者排便功能均恢复正常。结论:伴有瘫痪症状的脊柱转移癌患者经放疗、化疗及综合康复治疗后疼痛情况及肢体肌力、排便功能均有不程度的缓解和改善。影响其脊髓功能恢复的因素主要是病程长短、脊髓受压迫程度、转移病灶数量、患者体质情况及初次康复治疗时间、质量等。同时应注重对患者进行心理辅导,以提高其生活质量。
Background: Spinal metastases are often complicated by pain, limited mobility and paralysis, with poor prognosis. Objective: To explore the factors that affect the spinal cord function recovery of spinal metastatic carcinoma and its treatment methods, in order to improve the quality of life of patients with advanced cancer. Design: the case of self-control observation. Unit: Department of Oncology and Radiotherapy, Affiliated Hospital of Guangdong Medical College. PARTICIPANTS: A total of 162 spinal metastatic cancer patients with paralytic symptoms were admitted to the Department of Oncology, Guangdong Medical College Affiliated Hospital from March 1992 to June 2001 with the intention of voluntarily participating in the study. Methods: ① Radiotherapy and chemotherapy: All patients were treated with symptomatic treatment combined with radiotherapy alone or radiotherapy combined with chemotherapy. The radiotherapy dose was 2Gy / time and 5 times / week for 3 weeks. Chemotherapy was performed according to different primary tumors Program, chemotherapy 2 to 6 cycles, an average of 3 cycles, each cycle 21d. ② rehabilitation therapy including exercise therapy, massage (2 / d), functional electrical stimulation (1 / d), urinary training and defecation training (once or twice daily), 10d for a course of treatment for 3 courses. Analgesic effect, limb muscle strength and defecation recovery were observed after treatment. MAIN OUTCOME MEASURES: Pain relief and limb muscle strength and defecation recovery after treatment. Results: All 162 patients entered the result analysis without shedding. ① pain relief in 97 cases (59.88%); no relief in 0 cases. ② muscle strength improved significantly in 127 cases (78.40%), no improvement in 35 cases (21.60%). Single lesions and adjacent 2 vertebral lesions patients, the improvement rate of muscle strength was 92.98%; multiple lesions improved muscle strength was 64.59%. Patients with a history of less than 2 weeks showed marked improvement in muscle strength and no improvement in strength in patients> 2 months. 21 patients before treatment CT or MRI showed serious spinal cord lesions, after treatment, only 2 cases of muscle strength, the rest without improvement. The defecation function of 162 patients returned to normal. Conclusion: The patients with spinal metastasis with paralysis have mild to moderate pain and limb muscle strength and bowel function after radiotherapy, chemotherapy and comprehensive rehabilitation. The main factors affecting the recovery of spinal cord function is the duration of the disease, the degree of compression of the spinal cord, the number of metastatic lesions, the patient’s physical condition and the initial rehabilitation treatment time, quality and so on. At the same time should pay attention to psychological counseling for patients to improve their quality of life.