文章：

症状性转移性硬膜外脊髓压迫患者的治疗延迟模式

Patterns of Treatment Delay in Patients with Symptomatic Metastatic Epidural Spinal Cord Compression

原文发布日期：10 February 2025

DOI: 10.3390/cancers17040595

类型: Article

开放获取: 是

英文摘要：

Background: Delays in the diagnosis and treatment of metastatic epidural spinal cord compression (MESCC) can potentially result in serious, deleterious effects on patient outcomes and postoperative morbidity. Delays may occur any at any step in the chain of care, increasing the risk of preventable complications. Objectives: This study, thus, aims to identify patterns of treatment delays and determine the predictive factors of postoperative ambulatory function in patients with symptomatic MESCC. Methods: Adult patients, aged >18 years, who underwent surgical treatment for MESCC between 2015 and 2022, were included for analysis in this retrospective study. Results: A total of 177 patients were included. The most significant delay contributing to total delay was patient delay (mean duration 41 days) followed by diagnostic delay (mean duration 16 days). Patients presenting acutely to the Emergency Department and patients with neurological deficits were found to have significantly shorter delays. Preoperative neurological deficits (p= 0.001) and preoperative red flag symptoms of cord compression (p= 0.008) were significant factors that were predictive of postoperative functional independence. Referral delay was also a significant predictive factor (p= 0.013); surgical delay approached statistical significance (p= 0.075). Conclusions: The results of this study highlight the need for increasing patient education, enhancing physician management of patients with MESCC, and improving diagnostic efficiency to reduce delays and maximize patient outcomes.

摘要翻译： 

背景：转移性硬膜外脊髓压迫（MESCC）的诊断与治疗延迟可能对患者预后及术后并发症产生严重不良影响。延迟可能发生在诊疗链的任一环节，从而增加可预防并发症的风险。目的：本研究旨在识别症状性MESCC患者的治疗延迟模式，并确定术后行走功能的预测因素。方法：本研究为回顾性分析，纳入2015年至2022年间接受手术治疗的18岁以上成年MESCC患者。结果：共纳入177例患者。导致总延迟的最主要环节是患者延迟（平均41天），其次是诊断延迟（平均16天）。研究发现，急性就诊于急诊科的患者及存在神经功能缺损的患者延迟时间显著缩短。术前神经功能缺损（p=0.001）与术前脊髓压迫警示症状（p=0.008）是预测术后功能独立性的显著因素。转诊延迟也是重要预测因素（p=0.013），手术延迟接近统计学显著性（p=0.075）。结论：本研究结果提示，需加强患者教育、优化临床医生对MESCC患者的管理并提升诊断效率，以减少诊疗延迟并最大化改善患者预后。

原文链接：

Patterns of Treatment Delay in Patients with Symptomatic Metastatic Epidural Spinal Cord Compression