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目的针对一例晚期肺癌脊柱转移患者病情和治疗预期,结合最新的循证医学证据,制定治疗决策。方法按照PICO原则,对患者在治疗中面临的问题进行转换并制定检索策略后,在多个数据库中进行文献检索。按照循证医学5级证据分级标准,选择最佳的临床证据进行解读,并指导治疗决策。结果检出相关文献148篇,最终纳入4篇系统评价/Meta分析。针对患者关心的4个方面的问题均获得1级证据支持,包括恢复脊髓功能(行走和括约肌功能)、局部疼痛控制、远期生存率和治疗并发症。根据患者意愿,最终选择了治疗后并发症相对高发,但能够更好恢复神经功能,显著缓解疼痛,提高远期生存率的手术减压治疗。术后患者行走功能完全恢复。结论采用循证治疗方法,能为肺癌脊柱转移伴脊髓压迫患者选择合理的治疗方案。对于恶性脊髓压迫患者,如出现行走功能障碍,且具备手术条件,应尽早进行减压手术,以尽早恢复脊髓功能,缓解疼痛,提高远期生存率。但医患双方均应对手术治疗存在较高的并发症风险有充分的共识和谅解。
Aim To treat the condition and treatment expectation of patients with spine metastasis of advanced lung cancer and to make the decision of treatment based on the latest evidence-based medicine. Methods According to the principle of PICO, the patients were transformed in the treatment of the problems and the development of search strategies, the literature search in multiple databases. According to evidence-based medicine grade 5 evidence grading standards, choose the best clinical evidence to interpret and guide treatment decisions. Results A total of 148 articles were detected and finally included in 4 systematic reviews / meta-analyzes. Level 1 evidence-based support is available for all four areas of concern to patients, including recovery of spinal cord function (walking and sphincter function), local pain control, long-term survival, and treatment of complications. According to the patient’s wishes, the final choice of the treatment of complications is relatively high, but can better restore neurological function, significantly relieve pain and improve the long-term survival rate of surgical decompression. Postoperative patients fully functional recovery. Conclusion The evidence-based treatment can be used to select a reasonable treatment for patients with spinal metastases of spinal cord with spinal cord compression. For patients with malignant spinal cord compression, such as walking dysfunction, and with surgical conditions, decompression surgery should be carried out as soon as possible to restore spinal cord function as soon as possible to ease the pain and improve long-term survival. However, both doctors and patients should have sufficient consensus and understanding on the high risk of complications in surgical treatment.