显微镜辅助后路经肋横突入路胸椎管内外哑铃形肿瘤切除术16例  

Clinical analysis of dumbbell tumors inside and outside the thoracic spinal canal using microscope assisted resection by costotransverse approach： report of 16 cases

作　　者：张吉涛 陈佳 王文涛[1] 李政 郝定均[1] 单乐群 Zhang Jitao;Chen Jia;Wang Wentao;Li Zheng;Hao Dingiun;Shan Lequn(Department of Spine Surgery,Xi＇ an Honghui Hospital Affiliated to Medical College of Xi＇an Jiaotong University,Xi＇an 710054,China)

机构地区：[1]西安交通大学附属红会医院脊柱外科,西安710054 [2]空军军医大学唐都医院骨科 [3]解放军第一五三中心医院手外科

出　　处：《中华解剖与临床杂志》2018年第3期178-183,共6页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金（30901784、81272072）;陕西省社会发展科技攻关项目（2016SF-115）

摘　　要：目的探讨显微镜辅助后路经肋横突人路切除椎管内外哑铃形肿瘤的安全性、疗效及优势。方法采用回顾性横断面研究方法。纳入2011年1月-2017年6月在空军军医大学附属唐都医院行胸椎管内外哑铃形肿瘤切除术治疗的16例患者的临床资料，其中男10例、女6例，年龄20～69岁。16例患者术前均行X线、CT及MRI检查，7例行术前穿刺活检术。术中均取后路经肋横突入路显露病变节段，显微镜下切除病变侧椎板、小关节、横突及肋骨，之后采用显微外科技术一期手术切除椎管内外肿瘤，后路钉棒系统固定融合减压节段。观察手术前后感觉、运动障碍恢复情况，统计术前、术后神经功能美国脊髓损伤学会（ASIA）评分，观察术后血气胸发生率、肿瘤复发率及继发畸形发生情况。结果本组肿瘤均完全切除，术后病理学检查报告神经鞘瘤9例，神经纤维瘤3例，脊膜瘤2例，黑色素瘤1例，骨软骨肉瘤1例。术后随访6-36个月，术后神经根性疼痛以及感觉、运动功能障碍明显改善。术前及术后3个月、末次随访ASIA感觉评分分别为（179．75±90．45）分、（194．87±36．75）分和（209．50±19．25）分，ASIA运动评分分别为（83．25±32．75）分、（90．56±15．75）分和（94．56±13．75）分，术前与术后3个月、术后3个月与末次随访时的ASIA感觉和运动评分差异均有统计学意义（P值均〈0．01）。术后均无血气胸发生，未放置胸腔闭式引流，随访期间无一例肿瘤复发，无脊柱继发畸形发生。结论采用显微镜辅助经肋横突人路手术可以一期切除胸椎管内外哑铃形肿瘤，术后症状改善明显，神经功能恢复良好；同时避免开胸手术，减少手术创伤并降低术后对呼吸功能影响，手术安全有效。Objective To explore the safety, efficacy and advantages of microscope assisted posterior costotransverse approach resection of dumbbell tumors inside and outside the spinal canal. Methods A retrospective cross-sectional study was conducted. Clinical data of 16 patients with dumbbell tumors inside and outside the thoracic spinal canal in Tangdu Hospital of the Fourth Military Medical University between January 2011 and June 2017 were collected. Among them, there were 10 males and 6 females, aged 20 - 69 years, with an average of 47.2 years. All the patients were examined by X-ray, CT and MRI. During operation, all the lesion segments were exposed by posterior costotransverse approach. The lateral laminae, facet joints, transverse processes and ribs were resected under microscope. Then microsurgical technique was used to remove the tumors inside and outside the spinal canal in one stage operation following by posterior screw-rod fixation of decompression and fusion segments. To compare the changes of sensory and motor dysfunction between before and after operation. American Spine Injury Association（ASIA） scores was used to assess the neurologic function of the 16 patients. The incidence rate of hemonneumothorax, recurrence rate of tumor and secondary malformation of the 16 natients after oneration were observed. Results All the tumors were completely resected in this group. Tumor properties： neurilemmoma in 9 cases, neurofibroma in 3 cases, meningioma in 2 cases, melanoma in 1 case, and osteochondrosarcoma in 1 case. All patients were followed up for 6 - 36 months. After operation, the symptoms such as nervous radical pain, sensory disturbance, dyskinesia, and sphincter dysfunction were improved obviously. The ASIA score of 3 months postoperative （ 194. 87 ± 36.75 ） and last follow-up （209.50 ± 19.25 ） was significantly higher than that before surgery [ （ 179.75 ± 90.45 ）, all P values 〈 0.01 ] ; And the ASIA sports score after operation （90.56 ± 15.75, 94.56 ± 13.75 ） was also signifi

关 键 词：脊椎肿瘤 椎管肿瘤 胸椎 显微外科手术 哑铃形肿瘤 

分 类 号：R739.42[医药卫生—肿瘤]