Ⅰ期后入路手术切除胸椎神经源性哑铃型肿瘤的解剖学及其疗效  

Clinical outcomes and anatomic evaluation of the single-stage posterior approach for management of Neurogenic thoracic dumbbell tumors

作　　者：龙厚清[1] 黄荷 谢文翰[1] 黄阳亮[1] 刘少喻[1] 李佛保[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广州510700 [2]广州市中西医结合医院骨科,广州510800

出　　处：《中国临床解剖学杂志》2013年第5期586-590,共5页Chinese Journal of Clinical Anatomy

摘　　要：目的探讨Ⅰ期后路经肋横突切除入路摘除胸椎哑铃型肿瘤的解剖学可行性和安全性。方法回顾2006.8-2011.10间收治的20例胸椎哑铃状肿瘤的临床资料,均采用单一后路Ⅰ期手术切除肿瘤。JOA评价神经功能,X线评估内固定和融合结果,MRI检查肿瘤切除彻底性和是否复发。结果肿瘤均完全切除,平均手术时间263min(152~420 min),出血量480 ml(125~1770 ml)。Schwann细胞瘤9例,神经纤维瘤6例,脊膜瘤3例,神经节细胞瘤2;其中硬膜外12例、髓外硬膜下8例。随访末期神经功能显著改善,JOA恢复率72.9%;VAS评分由术前8.3±0.67改善为随访末期2.3±0.19;并发症包括胸膜破裂2例,肺不张和胸腔内脑脊液漏各1例。结论单一后方肋横突、椎板切除入路可以完整切除胸椎哑铃型肿瘤,适用于肿瘤与大血管、胸腔脏器粘连较轻者。Objective To evaluate the anatomic feasibility and security of a single-stage posterior approach with costotransversectomy only for the management of thoracic dumbbell tumors. Methods The clinical and radiologic data of 20 cases of thoracic dumbbell tumor between 2006 to 2011 were analyzed retrospectiveiy. All patients underwent single-stage removal of dumbbell tumors by a posterior approach followed by laminectomy and costotransversection combined with instrumentation. Clinical and radiologic outcomes were evaluated. Neurological function was evaluated by the JOA score before surgery and at the final follow-up, the effect of internal fixation and fusion was evaluated by X-ray, and observance of whether the tumor was resected completely or tumor recurred at the final follow-up were made by MRI. R^ulta Operative time ranged from 152 to 420 minutes （mean, 263 minutes）, with estimated blood loss ranging from 125 to 1770 mL （mean, 480 mL）. All cases （including 12 cases in the epidural space and 8 cases in subdural space） had tumors removed completely. Pathologic findings included schwannoma in 9, neurofibroma in 6 , spinal meningioma in 3 and ganglioneuroma in 1 case. Postoperative complications included atelectasis in 1 case. The neurological function was significantly improved at the end of the follow-up, the recovery rate of JOA score was 72.9%; the VAS score was reduced from 8.3_＋0.67 before surgery to 2.3_＋0.19 at the end of follow-up. Spinal deformities, and tumor recurrence were not observed in any patients at the final follow-up; postoperative complications include pleural injury in 2 cases, pulmonary atelectasis in 1 case and cerebrospinal leak within the chest in 1 case. Conclusion Single-stage posterior approach with costotransversectomy may be a good choice for neurogenic thoracic dumbbell that has slight adhesion to great vessel and lung.

关 键 词：胸椎 哑铃型肿瘤 Ⅰ期后路手术 

分 类 号：R739.42[医药卫生—肿瘤]