课件：脊髓压迫.ppt

治疗原则 From NCCN Guidelines v2.2011 治疗原则 e. The recommended minimum dose of steroids is 4 mg of dexamethasone every 6 hours, although dose of steroids may vary (10-100 mg). h. Tumor resection with or without spinal stabilization. Surgery should be focused on anatomic pathology. From NCCN Guidelines v2.2011 治疗原则 Regarding surgery, note the following: Category 1 evidence supports the role of surgery in patients with epidural(硬膜外) spinal cord compression willing to undergo surgery. For surgery, patients with hematologic tumors (lymphoma, myeloma, leukemia) should be excluded, life expectancy should be ≥3 mo, and the patient should not be paraplegic for 24 h. surgery is especially indicated if the patient has any of the following: spinal instability, no history of cancer, rapid neurologic deterioration during RT, previous RT to site, and single site spinal cord compression. 治疗原则 Radiation Therapy Primary spinal cord tumors: doses of 45~50.4 Gy are recommended using fractions of 1.8 Gy. Metastatic spine: doses to vertebral body metastases will depend on patient’s performance status and primary histology. Generally doses of 20~37.5 Gy are delivered in 5~15 fractions over 1~3 weeks. In selected cases, or recurrences after previous radiation, stereotactic radiotherapy is appropriate. From NCCN Guidelines v2.2011 预后 预后决定因素很多，如病变性质、解除压迫可能性及程度 髓外硬膜内肿瘤多为良性，手术切除预后良好；髓内肿瘤预后较差。 通常受压时间越短，脊髓功能损害越小，越可能恢复功能。 急性脊髓压迫因不能充分代偿，预后较差。 Acknowledgement Thanks for your attention! 脊髓压迫症 定义 脊髓压迫症（spinal cord compression） 是在椎管内占位性病变引起脊髓受压综合征，随着病变进展出现脊髓半切和横贯性损害及椎管梗阻，脊神经根和血管可不同程度受