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[目的]对比分析肺癌脊柱转移患者手术治疗和放射治疗的临床疗效。[方法]回顾性分析2004年6月～2010年12月肺癌脊柱转移患者24例。男14例,女10例;年龄40～65岁,平均53.4岁。放射治疗组15例,其中4例联合化疗、2例联合靶向治疗;手术治疗组9例,均为开放手术且应用脊柱内固定,其中2例患者联合化疗、3例联合靶向治疗,治疗后对患者进行随访并进行生存分析,术前、术后1个月及术后3个月应用视觉模拟评分(visualanalogue scale,VAS)评估疼痛,术前、术后3个月分别应用Frankel分级对脊髓损伤进行评估,应用卡式(Karnofsky,KPS)评分系统对功能状态进行评分。[结果]随访2～16个月,平均随访8.3个月。放疗组平均生存时间7.7个月,中位生存时间为7.0个月;手术治疗组平均生存时间为9.3个月,中位生存时间为8.4个月,手术治疗组生存时间较放疗组无统计学差异(P>0.05);对治疗前、后1、3个月疼痛VAS评分进行统计学分析,手术治疗组和放疗组治疗后疼痛缓解程度较治疗前均具有统计学意义,并且手术治疗组治疗后1、3个月疼痛缓解程度均优于放疗组,具有统计学意义(P<0.01);手术治疗组术后3个月Frankel分级D、E级比例由术前的77.8%提高到88.9%,放疗组由治疗前的66.7%提高到73.3%;手术治疗组KPS评分80～100分比例较治疗前提高22.2%,放疗组提高13.3%。手术治疗组脊髓损伤和功能状态缓解程度均优于放疗组。[结论]肺癌脊柱转移患者采取手术治疗与放射治疗相比,能够延长生存时间,但无统计学差异,同时应用手术治疗后能够明显减轻疼痛、改善功能、提高生存质量。
[Objective] To compare the clinical efficacy of surgical treatment and radiotherapy in patients with spine metastasis of lung cancer. [Methods] A total of 24 patients with spine metastasis of lung cancer from June 2004 to December 2010 were retrospectively analyzed. 14 males and 10 females; aged 40 to 65 years, an average of 53.4 years old. Radiotherapy group of 15 cases, of which 4 cases of combined chemotherapy, 2 cases of combined targeted therapy; surgery group of 9 patients were open surgery and spinal fixation, 2 patients combined with chemotherapy, 3 cases of combined targeted therapy, treatment Patients were followed up and analyzed for survival. Preoperative, postoperative 1 month and postoperative 3 months were evaluated by visual analog scale (VAS) for pain assessment. Frankel grading was performed preoperatively and 3 months postoperatively Spinal cord injuries were assessed and functional status was scored using a Karnofsky (KPS) scoring system. [Results] The patients were followed up for 2 to 16 months with an average of 8.3 months follow-up. The average survival time of radiotherapy group was 7.7 months, and the median survival time was 7.0 months. The mean survival time of the operation group was 9.3 months and the median survival time was 8.4 months. There was no significant difference between the two groups (P> 0.05). The VAS score of pain before and after 1, 3 months after operation were statistically analyzed. The degree of pain relief after operation in both operation and radiotherapy groups was statistically significant than that before treatment, and after operation, The degree of pain relief at 1 month and 3 months was better than that of radiotherapy group (P <0.01). The Frankel grade D and E grade at 3 months after operation in operation group increased from 77.8% to 88.9% Radiotherapy group increased from 66.7% before treatment to 73.3%. Surgical treatment group KPS score 80 ~ 100 ratio increased 22.2% before treatment, radiotherapy group increased 13.3%. Surgical treatment group spinal cord injury and functional status were better than radiotherapy group. [Conclusion] Surgical treatment of patients with spine metastasis of lung cancer can prolong the survival time compared with radiotherapy, but there is no statistical difference. At the same time, the surgery can significantly reduce the pain, improve the function and improve the quality of life.