颈椎哑铃型肿瘤的临床分型及手术入路的选择  

Clinical classification and selection of surgical approaches for cervical spinal dumbbell tumors

作　　者：陈海锋[1] 李丹[1] 王跃龙[1] 刘家刚[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610041

出　　处：《中华医学杂志》2014年第19期1444-1447,共4页National Medical Journal of China

基　　金：四川省科技支撑计划（2011SZ0222）

摘　　要：目的 探讨颈椎哑铃型肿瘤的临床分型及手术入路的选择.方法 回顾性分析四川大学华西医院神经外科2005年1月至2012年12月采用外科手术治疗的87例颈椎哑铃型肿瘤患者的临床资料.根据肿瘤椎管内外部分的大小以及有无脊柱骨质结构破坏将颈椎哑铃型肿瘤分为4型：椎管内为主型（Ⅰ型,48例）、椎管外为主型（Ⅱ型,17例）、椎管内外无骨质破坏型（Ⅲ型,15例）和椎管内外伴骨质破坏型（Ⅳ型,7例）.根据肿瘤分型分别采用不同的手术入路一期切除肿瘤,其中Ⅰ型采用颈后正中-半椎板入路,Ⅱ型采用颈外侧-肌间隙入路,Ⅲ型采用颈外侧-肌间隙-半椎板入路或颈外侧-肌间隙-颈后正中-半椎板联合入路,Ⅳ型采用颈后远外侧-肌间隙-半椎板入路或颈后正中-肌间隙-半椎板入路并行枕颈后路或颈椎后路植骨融合内固定.结果 肿瘤一期手术完全切除83例,次全切除4例.术后随访9个月～6（3.2）年,肿瘤全切病例均无复发,次全切病例复发1例.随访期间患者临床症状改善85例,加重2例,无发生脊柱畸形的病例.结论 颈椎哑铃型肿瘤的临床分型对手术入路的选择具有重要的指导意义,根据肿瘤分型采用相应的手术入路不仅能够提高肿瘤一期切除的全切率,而且有助于降低术后脊柱畸形的发生率.Objective To explore the clinical classification and selection of surgical approaches for cervical spinal dumbbell tumors.Methods The clinical data of 87 patients with cervical spinal dumbbell tumors undergoing surgical operations from January 2005 to December 2012 at our hospital were analyzed retrospectively.According to the size of inner and outer parts of tumors and the presence or absence of spinal bone damage,the cervical spinal dumbbell tumors were divided into 4 types of intraspinal predominant （Ⅰ,n =48）,extraspinal predominant （Ⅱ,n =1）,intrapinal and extraspinal without damage of spinal bone （Ⅲ,n =15） and intrapinal and extraspinal type with damage of spinal bone （Ⅳ,n =7）.Different surgical approaches were selected on the basis of tumor classification：posterior median-hemilamina approaches for type Ⅰ tumors,lateral-muscle gap approaches for type Ⅱ tumors,ateral-muscle gap-hemilamina or lateralmuscle gap-posterior median-hemilamina approaches for type Ⅲ tumors,posterior far lateral-muscle gaphemilamina or posterior median-muscle gap-hemilamina approaches plus posterior occipital cervical or cervical spinal bone graft fusion and internal fixation for type Ⅳ tumors.Results Among them,83 cases underwent total resection and another 4 subtotal resection in one-stage operation.The postoperative follow-up period had a range of 9 months to 6 years （mean,3.2 years）.There was no recurrence of tumors for total resection and 1 case of tumor recurrence for subtotal resection.During the follow-up period,the clinical manifestations of 85 patients improved while another 2 deteriorated.And there was no occurrence of spinal deformity.Conclusion Clinical classification of cervical spinal dumbbell tumor plays an important guiding role in the selection of surgical approaches.Adopting appropriate surgical approaches based on tumor type can not only improve the rate of total resection of tumor but also reduce the incidence of postoperative spinal deformity.

关 键 词：颈椎 哑铃型肿瘤 临床分型 手术入路 

分 类 号：R739.4[医药卫生—肿瘤]