一期后路全脊椎切除术治疗多椎节脊柱肿瘤

发布时间：2018-07-18 21:09

【摘要】：目的 :探讨一期后路全脊椎切除术治疗多椎节脊柱肿瘤的安全性和有效性。方法 :回顾性分析2009年11月~2015年9月因多椎节脊柱肿瘤于我院行全脊椎切除术(total en bloc spondylectomy,TES)且资料完整的9例患者,男8例,女1例;年龄42.0±13.7岁(24~64岁)。原发肿瘤5例,其中骨巨细胞瘤2例,恶性神经鞘膜瘤、造釉细胞瘤、间叶源性肿瘤各1例;转移性肿瘤4例,其中肾癌、肝癌、前列腺癌、脂肪肉瘤各1例。记录手术时间、术中出血量、输血量、并发症、住院天数、术前及术后疼痛程度、神经功能情况。术后随访观察肿瘤是否复发、远处转移以及患者存活情况。结果:9例患者均成功接受一期后路多椎节全脊椎切除术,其中2椎节切除6例,3椎节2例,4椎节1例。手术时间8.9±2.8h(7~16h)、术中出血量3422.2±1342.4ml(1700~6000ml)、输血量2200.0±842.6ml(1000~4000ml)、住院时间31.1±20.3d(14~73d)。3例患者术中硬膜撕裂,1例胸膜破裂,3例患者术后出现胸腔积液,1例4椎体切除患者术后出现胸腔感染,无神经、大血管损伤等严重并发症。围手术期无死亡病例。1例患者随访期间出现钛网下沉,其他无内固定并发症。术后VAS评分(0.9±1.1分)较术前(7.1±1.2分)明显下降(P0.05)。术前脊髓神经功能5例ASIA分级为E级,术后仍为E级;3例术前D级,2例恢复至E级,1例仍为D级;1例术前C级,术后恢复至D级。9例患者均得到随访,随访时间29.8±15.2个月(12~61个月),随访期内6例患者局部无肿瘤复发,另3例患者分别于术后8个月、18个月、28个月时发现手术部位局部肿瘤复发。4例死亡,其中3例因全身多发转移死亡,1例死于肿瘤复发引起的并发症,中位生存期为34.75个月。结论:一期后路全脊椎切除术治疗多椎节脊柱肿瘤仍是高风险、高难度手术,但是可以术后即刻改善患者生活质量,需严格把握手术指征。
[Abstract]:Objective: to evaluate the safety and efficacy of one-stage posterior total spinal resection in the treatment of multiple spinal tumors. Methods: from November 2009 to September 2015, 9 patients (8 males and 1 female) who underwent (total en bloc spondylectomy tes in our hospital were retrospectively analyzed. The age was 42.0 卤13.7 years (240-64 years). There were 5 cases of primary tumor, 2 cases of giant cell tumor of bone, 1 case of malignant nerve sheath tumor, 1 case of ameloblastoma, 1 case of mesenchymal tumor, 4 cases of metastatic tumor, including 1 case of renal carcinoma, 1 case of liver cancer, 1 case of prostate cancer and 1 case of liposarcoma. The operative time, intraoperative blood loss, blood transfusion, complications, hospitalization days, preoperative and postoperative pain and neurological function were recorded. Tumor recurrence, distant metastasis and survival were observed after operation. Results all 9 cases underwent one stage posterior multisegmental total spondylectomy, of which 6 cases were resected with 2 cases and 3 cases were treated with 3 vertebrae and 1 case with 4 vertebrae. The operative time was 8. 9 卤2. 8 hours (7 / 16), intraoperative bleeding was 3422.2 卤1342.4ml (1700~6000ml), blood transfusion was 2200.0 卤842.6ml (1000~4000ml), hospitalization time was 31. 1 卤20. 3 days (14: 73d) in 3 patients with intraoperative dura tear, 1 patient with pleural rupture and 3 patients with pleural rupture. Major vascular injury and other serious complications. There were no death cases in perioperative period. 1 cases had titanium mesh sinking during follow-up, and no other internal fixation complications. The VAS score (0.9 卤1.1) was significantly lower than that before (7.1 卤1.2) (P0.05). The neurological function of spinal cord was classified as grade E in 5 cases before operation, in 3 cases of grade E after operation, in 2 cases of grade D to grade E before operation, in 1 case of grade D grade C before operation, and in 9 cases of patients who recovered to grade D after operation. The follow-up time was 29.8 卤15.2 months (12 ~ 61 months). During the follow-up period, 6 patients had no local tumor recurrence, and 3 patients had local tumor recurrence at 8 months, 18 months and 28 months after operation, respectively. 3 cases died of multiple metastases and 1 case died of complications caused by tumor recurrence. The median survival time was 34.75 months. Conclusion: one stage posterior total spinal resection is still a high risk and difficult operation for multiple spinal tumors, but it can improve the quality of life of patients immediately after operation, so the indication of operation should be strictly grasped.
【作者单位】：复旦大学附属中山医院骨科;
【分类号】：R738.1

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