Sundaresan N, Choi I S, Hughes J E, Sachdev V P, Berenstein A
Department of Neurosurgery, Mount Sinai Hospital and Medical School, New York, New York.
J Neurosurg. 1990 Oct;73(4):548-54. doi: 10.3171/jns.1990.73.4.0548.
Surgical treatment of bone metastases from kidney cancer is often complicated by profuse blood loss. The authors report the results of a retrospective review of 30 consecutive patients who underwent surgery for spinal metastases from kidney cancer. Seventeen patients (57%) were operated on after failing radiation therapy. Prior to operation, selective spinal angiography and embolization were performed in 17 patients with no permanent neurological deficits resulting. Gross total resection of the tumor and stabilization of the spine were then accomplished with acceptable blood loss. Twenty-seven (90%) of the 30 patients improved neurologically following surgery. There was a median survival time of 16 months, a 2-year survival rate of 33%, and a 5-year survival rate of 15%. Major surgical complications in this series were related to excessive blood loss in patients without embolization. These data suggest that patients with spinal metastases from kidney cancer should undergo spinal angiography and embolization prior to resection of the tumor. To improve upon current results, such treatment should be carried out prior to external radiation therapy.
肾癌骨转移的手术治疗常因大量失血而复杂化。作者报告了对30例连续接受肾癌脊柱转移瘤手术患者的回顾性研究结果。17例患者（57%）在放疗失败后接受了手术。术前，17例患者接受了选择性脊柱血管造影和栓塞，未导致永久性神经功能缺损。随后，在可接受的失血量情况下完成了肿瘤的全切除和脊柱稳定。30例患者中有27例（90%）术后神经功能得到改善。中位生存时间为16个月，2年生存率为33%，5年生存率为15%。本系列中的主要手术并发症与未接受栓塞患者的失血过多有关。这些数据表明，肾癌脊柱转移患者在切除肿瘤前应接受脊柱血管造影和栓塞。为改善目前的结果，这种治疗应在体外放疗之前进行。
