胸腔镜联合半椎板切除治疗胸椎管哑铃型肿瘤  

Combined thoracoscopic and semi-laminectomy for thoracic spinal canal dumbbell-shaped tumor

作　　者：冀培刚[1] 李进[1] 贾禄[1] 杨开勇[1] 黄思庆 

机构地区：[1]四川大学华西医院神经外科,成都市610041

出　　处：《中国脊柱脊髓杂志》2010年第1期39-42,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨胸腔镜联合半椎板切除治疗胸椎管哑铃型肿瘤的临床疗效。方法:2007年6月至2009年1月收治6例胸椎管哑铃型肿瘤患者,男4例,女2例。年龄25～63岁,平均35.5岁,均采用胸腔镜联合后正中入路半椎板开窗切除病变。术后随访观察临床疗效并行MRI检查,观察肿瘤切除情况及对脊柱稳定性的影响。结果:6例患者均手术全切肿瘤,无1例死亡。手术时间3～5h,平均3.8h;术中失血量80～300ml,平均130ml。伤口均一期愈合,无脑脊液漏及切口、胸腔感染发生。病理检查结果示神经鞘瘤5例,脊膜瘤1例。术后患者症状均有不同程度缓解,5例有胸背疼痛患者疼痛消失,3例术前有脊髓压迫症状者,其中2例完全恢复,1例双下肢瘫痪者术后肌力恢复至4+级。复查MRI均未见肿瘤残留。随访6个月～2年,所有患者均未见肿瘤复发及脊柱不稳定。结论:应用胸腔镜联合半椎板开窗切除胸椎管哑铃型肿瘤有较好的临床疗效。Objective：To investigate the clinical efficacy of combined thoracoscopic and semi-laminectomy for the treatment of thoracic spinal canal dmnbbell-shaped tumor.Method：Six patients complicated with thoracic spinal canal dumbbefl-shaped tmnor experienced combined thoracoscopic and semi-laminectomy between July 2007 and January 2009.There were 4 males and 2 females with an average age of 35.5 years（range,25 to 63 years）.The clinical outcome was evaluated and the status of tumor excision as well as effect on spine stability were also assessed by MRI during follow up.Result：Complete tumor excision was performed in all cases with no death noted.The average surgical time was 3.8h （range,3 to 5h）.The average blood loss was 130ml（range, 80 to 300ml）.All skin excision healed well,with no case of cerebrospinal fluid leakage and chest cavity in- fection.Parthenogenesis included neurilemmoma （5 cases） and meningioma （1 ease）.All patients had clinical symptoms improved.Thoracodorsal pain disappeared in all cases,2 of 3 cases with spinal cord compression preoperatively had neurofunction improved completely,while another case had muscle strength of lower limbs recovered to level 4＋.No tumor recurrence and spine instability was noted in 2-years follow-up.Conclusion： Combined thoracoseopic and semi-laminectomy indicated for thoracic spinal canal dumbbell-shaped tumor is feasible and safety.

关 键 词：哑铃型肿瘤 胸椎 胸腔镜 半椎板切除 

分 类 号：R739.4[医药卫生—肿瘤]