摘要
目的针对一例晚期肺癌脊柱转移患者病情和治疗预期,结合最新的循证医学证据,制定治疗决策。方法按照PICO原则,对患者在治疗中面临的问题进行转换并制定检索策略后,在多个数据库中进行文献检索。按照循证医学5级证据分级标准,选择最佳的临床证据进行解读,并指导治疗决策。结果检出相关文献148篇,最终纳入4篇系统评价/Meta分析。针对患者关心的4个方面的问题均获得1级证据支持,包括恢复脊髓功能(行走和括约肌功能)、局部疼痛控制、远期生存率和治疗并发症。根据患者意愿,最终选择了治疗后并发症相对高发,但能够更好恢复神经功能,显著缓解疼痛,提高远期生存率的手术减压治疗。术后患者行走功能完全恢复。结论采用循证治疗方法,能为肺癌脊柱转移伴脊髓压迫患者选择合理的治疗方案。对于恶性脊髓压迫患者,如出现行走功能障碍,且具备手术条件,应尽早进行减压手术,以尽早恢复脊髓功能,缓解疼痛,提高远期生存率。但医患双方均应对手术治疗存在较高的并发症风险有充分的共识和谅解。
Objective To establish the evidence-based treatment strategy for an advanced lung cancer case with spinal metastasis, regarding the patient＇s condition and treatment expectations. Methods According to PICO principles, questions in the patient＇s treatment were converted into a search strategy. The literature searching was performed in sever- al databases. In accordance with the five evidence grading standards in evidence-based medicine, the best clinical evidence was interpreted to guide the treatment decisions. Results A total of 148 papers were detected and screened, of which 4 systematic reviews or meta-analyses were included finally. Four issues that patients concerned, including restoring spinal cord function （walking and sphincter function）, local pain control, long-term survival, and treatment complications, were all supported by grade- 1 evidence. The patient finally chose surgical decompression, which was of a higher complication risk, but better possibility of restoring nerve function, significant pain relief, and improved long-term survival. The patient obtained fully recovery and regained walking function after surgery. Conclusion The evidence-based treatment is able to provide reasonable treatment options for lung cancer patients with spinal metastasis. Decompression surgery for patients with walking dysfunction should be carried out as soon as possible, in order to early restore spinal marrow function, re- lieve pain and improve long-term survival. But both doctors and patients should fully acquaint themselves with the higher risk of surgical complications.
出处
《中国循证医学杂志》
CSCD
2013年第6期768-772,共5页
Chinese Journal of Evidence-based Medicine
基金
四川省卫生厅科学研究项目资助(编号:090539)
关键词
肺癌
脊柱转移
循证治疗
Lung cancer
Spinal metastasis
Evidence-based treatment
