本文選題：脊柱非何杰金淋巴瘤 + 治療�。� 參考：《中國脊柱脊髓雜志》2017年04期

【摘要】：目的 :探討脊柱非何杰金淋巴瘤的治療方法選擇及療效。方法 :2006年6月~2012年11月我院骨科收治并獲隨訪的脊柱非何杰金淋巴瘤患者15例,男8例,女7例,年齡42±18歲(16~71歲)。局部疼痛14例。神經(jīng)功能損害11例,其中脊髓損害5例,Frankel C級3例,D級2例;馬尾損害6例。11例患者行CT引導(dǎo)下穿刺活檢,8例確診為淋巴瘤,1例誤診為Langerhans細胞增多癥,2例僅診斷為"小細胞惡性腫瘤",其余患者經(jīng)術(shù)后病理檢查確診。15例患者中,5例未接受手術(shù)治療,其中4例不伴嚴重神經(jīng)損害及節(jié)段不穩(wěn)定患者,經(jīng)穿刺活檢確診后,首選化療,均未接受進一步放療;1例患者為馬尾綜合征,無法耐受手術(shù),行急診放療,后行化療。10例接受手術(shù)治療,其中7例患者因神經(jīng)功能損害合并節(jié)段不穩(wěn)定行手術(shù)治療,術(shù)后1例患者未接受進一步治療,4例患者接受化療及放療,2例患者接受單純化療;1例患者行穿刺活檢未能確診,因節(jié)段不穩(wěn)定行手術(shù),病理檢查確診后接受化療;2例患者伴病理性骨折,行經(jīng)皮穿刺椎體成形術(shù)(percutaneous vertebroplasty,PVP),術(shù)后1例行化療,1例行化療+放療。手術(shù)患者術(shù)前Karnofsky日常狀態(tài)評分(Karnofsky performance score,KPS)為47±18分,疼痛視覺模擬評分(visual analog score,VAS)評分為7.7±1.0分;非手術(shù)患者治療前KPS為62±18分,VAS評分6.4±1.0分。結(jié)果:15例隨訪時間為52±34個月(3~108個月),其中5例死亡(分別存活3、10、10、15、25個月)。局部疼痛患者經(jīng)治療后癥狀均有緩解,其中3例完全緩解。11例神經(jīng)損害者,3例保守治療,8例手術(shù),手術(shù)患者中脊髓損傷4例,末次隨訪Frankel分級至少改善1級,其中2例完全恢復(fù),所有馬尾損傷患者均明顯恢復(fù)。手術(shù)患者末次隨訪時VAS評分為1.4±1.0分,較術(shù)前明顯降低(P0.05);末次隨訪時KPS評分為91±15分,較術(shù)前有顯著提高(P0.05)。非手術(shù)治療患者5例,4例存活,末次隨訪時VAS為1.0±0.6分,KPS為76±10分,與治療前比較均有統(tǒng)計學(xué)差異(P0.05)。所有患者預(yù)期5年生存率為66.7%,其中手術(shù)患者為60%,非手術(shù)患者為80%。結(jié)論:對于脊柱非何杰金淋巴瘤,化療及放療為最主要的治療手段;對于神經(jīng)損傷重、結(jié)構(gòu)不穩(wěn)定的患者,手術(shù)治療可有效解除脊髓壓迫、改善神經(jīng)功能及穩(wěn)定結(jié)構(gòu),提高生活質(zhì)量。
[Abstract]:Objective: to investigate the choice of treatment and curative effect of spinal non-Hodgkin's lymphoma. Methods: from June 2006 to November 2012, 15 patients with spinal non-Hodgkin 's lymphoma, 8 males and 7 females, aged 42 鹵18 years or 1671 years, were treated in our orthopedic department and followed up. Local pain was found in 14 cases. There were 11 cases of neurological impairment, of which 5 cases had spinal cord injury, 3 cases had grade C of Frankel C and 2 cases had grade D; CT-guided biopsy was performed in 6, 11 patients with cauda equina lesion. One case was misdiagnosed as Langerhans cell hyperplasia in 1 case, 2 cases were only diagnosed as "small cell malignant tumor", and 15 cases were diagnosed by pathological examination after operation. 5 cases were not treated by operation. Among them, 4 cases without serious nerve damage and segmental instability, after confirmed by puncture biopsy, the first choice of chemotherapy, none of them received further radiotherapy, one case was cauda equina syndrome, which could not tolerate surgery, and was treated with emergency radiotherapy. After chemotherapy, 10 patients received surgical treatment, 7 of them underwent surgical treatment because of neurological dysfunction and segmental instability. One patient received no further treatment, 4 patients received chemotherapy and 2 patients received chemotherapy alone. One patient underwent puncture biopsy and was operated on because of segmental instability. Two patients with pathological fracture were treated with chemotherapy after pathological examination. Percutaneous vertebroplasty and percutaneous vertebroplastic PVP were performed. One patient received chemotherapy and one received radiotherapy. The preoperative Karnofsky daily state score and visual analog score were 47 鹵18, 7.7 鹵1.0, 62 鹵18 and 6.4 鹵1.0, respectively. Results the follow-up time of 15 cases was 52 鹵34 months or 3 ~ 108 months, of which 5 cases died. The symptoms of patients with local pain were all relieved after treatment. Among them, 3 cases were completely relieved. 3 cases of nerve damage were treated conservatively in 8 cases of operation. 4 cases of spinal cord injury were operated on. The Frankel grade was improved at least 1 grade at the last follow-up. Two of them recovered completely, and all the patients with cauda equina injury recovered obviously. The VAS score at the last follow-up was 1.4 鹵1.0, which was significantly lower than that before operation (P 0.05), and the KPS score at the last follow-up was 91 鹵15, which was significantly higher than that before operation. Five patients with non-operative treatment survived, and the VAS at the last follow-up was 1. 0 鹵0. 6 and 76 鹵10. There was a significant difference compared with that before treatment (P 0. 05). The 5-year survival rate was expected to be 66. 7% for all patients, 60 for surgical patients and 80 for non-operative patients. Conclusion: for spinal non-Hodgkin 's lymphoma, chemotherapy and radiotherapy are the main treatment methods, and for patients with severe nerve injury and unstable structure, surgical treatment can effectively relieve spinal cord compression, improve nerve function and stable structure. Improve the quality of life.
【作者單位】： 北京大學(xué)第三醫(yī)院骨科;
【分類號】：R738

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