胸腔镜联合后路椎板减压治疗胸椎管内外哑铃型肿瘤  

Thoracoscope combining with posterior decompressive laminectomy to treat dumbbell-shaped tumor around thoracic spinal canal

作　　者：郎俊哲[1] 袁健东[1] 王靖[1] 滕红林[1] 刘爱海[2] 陈雷[1] 

机构地区：[1]温州医科大学附属第一医院骨科,浙江温州325000 [2]温州医科大学附属第二医院妇科,浙江温州325027

出　　处：《中国医药导报》2014年第3期33-35,38,共4页China Medical Herald

摘　　要：的探讨一期胸腔镜联合后路椎板减压切除胸椎管内外哑铃型肿瘤的疗效。方法回顾性分析2008年5月～2012年8月在温州医科大学附属第一医院行手术治疗的8例胸椎管内外哑铃型肿瘤患者的临床资料。所有患者均采用胸腔镜联合后路椎板减压切除病变，术后随访临床疗效并行MRI检查，观察肿瘤切除情况及对脊柱稳定性的影响。结果所有患者均行肿瘤全切除术，术后无死亡病例，伤口一期愈合，无创口、胸腔感染及脑脊液漏；病理检查结果显示，神经鞘瘤6例，神经纤维瘤1例，神经节细胞瘤1例：手术时间200～350min，出血80～350mL，随访时间为26．6个月（12～48个月），术后6例有胸背痛、3例有咳嗽、4例有脊髓压迫症状，均得到缓解，随访未见肿瘤复发及脊柱不稳定。结论后路椎板减压联合胸腔镜治疗胸椎管内外哑铃型肿瘤具有出血少、住院时间短、并发症少的特点。值得推广。Objective To discuss the therapeutic effect of thoracoscope combining with posterior decompressive laminectomy to treat one-stage dumbbell-shaped tumor around thoracic spinal canal. Methods Clinical data of 8 pa- tients with dumbbell-shaped tumor around thoracic spinal canal who were admitted into the First Affiliated Hospital of Wenzhou Medical University and all underwent thoracoscope combined with posterior decompressive laminectomy from May 2008 to August 2012 were retrospectively analyzed. After surgery, follow-up visit about clinical effect and MRI examination were carried out in order to observe the tumor excision and influence on spinal stability. Results All pa- tients accepted total tumor excision in operation without any death case after surgery. There was no wound infection, chest infection, or leakage of cerebrospinal fluid, and all the surgical wounds were healing by first intention. Outcomes of pathological examination indicated schwannoma in 6 cases, 1 case of neurofibroma, and 1 case of ganglioeytoma. The operation time lasted 200-350 rain. The amount of bleeding was 80-350 mL. The period of follow-up visits ranged 12- 48 months, with an average of 26.6 months. Symptoms after surgery were alleviated at different degrees. 6 patients with chest and back pain, 3 with cough, and 4 with spinal cord compression were alleviated. There was no tumor recurrence or spinal instability during follow-up visit. Conclusion In the treatment of dumbbell-shaped tumor around thoracic spinal canal, posterior decompressive laminectomy combined with thoracoscope has characteristics of little blood loss, short hospital stay, and few complications, which is worthy of expansion.

关 键 词：哑铃性肿瘤 胸腔镜 神经源性 后路椎板减压 胸椎管内外 

分 类 号：R738.1[医药卫生—肿瘤]