摘要
目的探讨DSA引导下射频消融术(RFA)联合经皮椎体成形术(PVP)治疗脊柱转移性肿瘤的手术方法、安全性和疗效。方法18例患者共31处椎体转移瘤,5处椎体后缘有骨质破坏。18例患者均有不同程度的胸背部或腰部疼痛,其中4例患者伴有不同程度的神经功能障碍,或脊髓受压症状(2例),所有患者在DSA引导下先行RFA,再行PVP,术后随访4～12周,采用视觉模拟评分(VAS)以及患者所需服用止疼药的剂量评价患者术前和术后疼痛,并分析其并发症等情况。并用SPSS 11.O统计软件,采用配对t检验对所得数据进行统计学分析。结果所有患者手术顺利,术后24 h VAS评分由术前平均8.17分降至4.5分,术后1个月降至2.5分,17例止痛药用量减少,1例维持原剂量。1处椎体发生椎间盘渗漏,3处椎体发生椎旁渗漏,2处椎体发生硬膜外渗漏,但临床无明显症状。结论DSA引导下RFA联合PVP治疗脊柱转移性肿瘤可获得良好的近期临床效果,其创伤小且安全可靠,可以明显提高患者生存质量。
Objective To discuss the technical points, safety and clinical effectiveness of DSA- guided radiofrequency ablation （RFA） therapy combined with percutaneous vertebroplasty （PVP） in treating spinal metastases. Methods Eighteen patients, including 10 males and 8 females, had altogether 31 vertebral metastases and presented with a chief complaint of a greater or less degree of thoracodorsal pain or lumbago. Posterior cortical defect of vertebral body was demonstrated in 5 lesions. Among the patients, four showed different degrees of dysneuria and two manifested the symptoms of spinal compression. Under DSA guidance, RFA was performed in all patients, which was followed by PVP. After the procedure, a follow-up for 1-12 weeks was conducted. The pain degree, both pre- and post-operative, was evaluated by visual analogue score （VAS） and the analgesic dosage taken by the patient. The results were statistically analyzed by using paired samples t test with SPSS 11.0 statistical software. Results The procedure was successfully completed in all patients. Pain rating with VAS before and 24 hours after the treatment was 8.17 and 4.5 respectively, the difference between the two was statistically significant （P 〈 0.01）. One month after the procedure, the pain rating was further decreased to 2.5 （P 〈 0.01 ）. The analgesic dosage taken by the patient was reduced in 17 cases, but was unchanged in one case. Bone cement leakage was observed on radiographs in 6 cases, including slight leakage into adjacent disc （n = 1, 5.6%）, into paravertebral soft tissues （n = 3,16.7%） and into intracanal epidural space （n = 2, 11.1%）, but clinically the patients showed no ohvious symptoms. Conclusions For the treatment of spinal metastases, DSA-guided radiofrequency ablation therapy combined with percutaneous vertebroplasty can obtain excellent short-term effect. This treatment is technically minimally-invasive and safe with reliable clinical results, besides, it can markedly improve the living quality of the patients.
出处
《介入放射学杂志》
CSCD
北大核心
2009年第5期362-366,共5页
Journal of Interventional Radiology
关键词
射频消融术
经皮椎体成形术
脊柱转移瘤
DSA引导
radiofrequency ablation
pereutaneous vertebroplasty
spinal metastasis
DSA-guidanee
作者简介
通信作者：吴春根
