Surgical treatment of spinal cord compression in kidney cancer.
Surgical treatment of spinal cord compression in kidney cancer.
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肾癌脊髓受压的手术治疗。
DOI：
10.1200/jco.1986.4.12.1851
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
I. Choi
中科院分区：
文献类型：
--
作者：
N. Sundaresan;H. Scher;G. Digiacinto;A. Yagoda;W. Whitmore;I. Choi
43例肾细胞癌患者在7年内接受了脊髓压迫治疗。其中，32名患者接受了手术，11名患者仅接受了放射治疗。术前，25名患者在既往放疗后复发，而另外7名患者接受了术后放疗。针对椎管内压迫部位，采用更具侵略性的手术入路，大多数患者通过前路进行肿瘤全切除。切除节段的甲基丙烯酸甲酯重建实现了脊柱的即时稳定。术前脊髓血管造影与栓塞的富血管肿瘤进行了8例。手术组和放疗组的患者参数相当，但单独放疗组中有更大比例的患者累及多个器官系统（64% v44%）。手术治疗患者的中位生存期为13个月，而单纯放射治疗患者的中位生存期为3个月。此外，与放射治疗（45%）相比，手术治疗的患者（70%）在神经方面受益更大。随着脊柱转移瘤有效手术治疗的发展，在选定的患者中应考虑早期手术治疗（放疗前）。建议在可行的情况下进行术前脊髓血管造影和栓塞，以尽量减少术中失血。
Forty-three patients with renal-cell carcinoma underwent treatment for spinal cord compression over a 7-year period. Of these, 32 patients underwent surgery, while 11 patients underwent radiation alone. Before operation, 25 patients had relapsed following prior radiation, while seven others received postoperative radiation. A more aggressive surgical approach, tailored to the site of compression within the spinal canal, was used with the majority undergoing gross total tumor resection by an anterior approach. Immediate stability of the spine was achieved with methyl-methacrylate reconstruction of the resected segments. Preoperative spinal angiography with embolization of hypervascular tumors was carried out in eight patients. Patient parameters in the surgical and irradiated groups were comparable, except that a greater proportion of the radiation alone group had more than one organ system involved (64% v 44%). The median survival of the surgically treated patients was 13 months, compared with 3 months for those treated by radiation alone. In addition, a greater proportion of the surgically treated patients were benefitted neurologically (70%) compared with those treated by radiation (45%). With the development of effective surgical treatment for spinal metastases, early consideration for surgical treatment (before radiation) should be considered in selected patients. Preoperative spinal angiography and embolization are recommended whenever feasible to minimize intraoperative blood loss.