脊柱恶性周围神经鞘膜瘤外科治疗及预后因素分析  

Malignant peripheral nerve sheath tumour in the spine:surgical treatment and prognosis factors

作　　者：王霆[1] 杨兴海[1] 肖建如[1] 

机构地区：[1]上海长征医院骨科,200003

出　　处：《国际骨科学杂志》2014年第3期196-198,共3页International Journal of Orthopaedics

摘　　要：目的 探讨影响脊柱恶性周围神经鞘膜瘤（MPNST）预后的因素.方法 回顾性分析24例经手术病理证实的脊柱MPNST患者临床及影像学资料、手术方式、术后放疗等因素,并通过Kaplan-Meier方法对比研究不同因素对脊柱MPNST预后的影响.结果 24例患者均接受手术治疗,其中肿瘤整块切除4例（16.7％）,肿瘤分块切除18例（75％）,肿瘤部分切除2例（8.3％）;14例接受术后放疗.术后随访4-98个月,术后半年、1年、2年、3年及5年生存率分别为70.8％、50％、37.5％、30.4％和23.1％.伴有椎体溶骨性破坏患者较不伴有椎体溶骨性破坏患者的预后明显更差（P=0.005）,不同手术方式对患者预后影响的差异有统计学意义（P =0.018）,接受术后放疗与未接受放疗患者的预后差异无统计学意义（P=0.789）.结论 手术方式和肿瘤是否侵犯椎体是影响脊柱MPNST预后的重要因素,而术后放疗对预后无明显作用.Objective To gain a better understanding of the factors influencing the prognosis of malignant peripheral nervesheath tumor （MPNST） in the spine. Methods Retrospective analysis of 24 patients with spinal MPNST proved by pathology inour hospital was conducted. The clinical data, imaging features, operation mode and postoperative radiotherapy were analyzed.Kaplan-Meier method was used to study the effects of different factors on the prognosis of spinal MPNST. Results Operationtreatment was given to all the 24 patients. Four cases （16. 7%） underwent en-bloc resection, 18 cases （75%） underwentpiecemeal resection, and 2 cases （8. 3%） underwent subtotal resection. Fourteen cases received postoperative radiotherapy.Twenty four patients were followed up from 4 to 98 months, the 0.5-, 1 , 2 , 3- and 5-year survival rates were 70.8%, 50. 0%,37. 5%, 30. 4% and 23. 1 - respectively. Compared with the prognosis of cases without vertebral osteolytic destruction, theprognosis of cases with vertebral osteolytic destruction was significantly worse （P = 0. 005）. Different operation mode have asignificant impact on the prognosis of the cases （P = 0. 018）. Postoperative radiotherapy showed no effect on the prognosis（P = 0. 789）. Conclusions The mode of operation and the invasion of vertebra are significant factors influencing the prognosis ofspinal MPNST. However, postoperative radiotherapy shows unclear benefits for spinal MPNST patients.

关 键 词：恶性周围神经鞘膜瘤 手术方式 术后放疗 预后因素 

分 类 号：R739.43[医药卫生—肿瘤]