内镜通道肌骨系统肿瘤外科技术在脊柱肿瘤中的应用  

The application of endoscopic tubular musculoskeletal tumor surgery in the treatment of spinal tumors

作　　者：王国文 张岩 许尧 赵成亮 韩秀鑫 张超 冯巾晏 刘永恒 申宇翔 冯哲 Wang Guowen;Zhang Yan;Xu Yao;Zhao Chengliang;Han Xiuxin;Zhang Chao;Feng Jinyan;Liu Yongheng;Shen Yuxiang;Feng Zhe(Department of Bone and Soft Tissue Tumors,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Tianjin's Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060,China;Department of Spinal Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]天津医科大学肿瘤医院骨与软组织肿瘤科,国家恶性肿瘤临床医学研究中心,天津市恶性肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津300060 [2]青岛大学附属医院脊柱外科,青岛266000

出　　处：《中华骨科杂志》2024年第20期1339-1348,共10页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金青年项目(82303076);全国重点实验室自主项目资助:药物成药性评价与系统转化重点实验室(QZ23-10);天津市教委科研计划项目(2022KJ225);天津市医学重点学科(专科)建设项目(TJYXZDXK-009A);天津医科大学肿瘤医院“十四五”高峰学科支持计划突出潜力学科。

摘　　要：目的探讨内镜通道肌骨系统肿瘤外科(endoscopic tubular musculoskeletal tumor surgery,ETMS)技术治疗脊柱肿瘤的可行性及安全性。方法回顾性收集2022年11月至2023年12月于天津医科大学肿瘤医院及青岛大学附属医院因脊柱肿瘤行ETMS治疗的患者18例,男11例、女7例,年龄为(60.3±8.6)岁(范围41~76岁);良性肿瘤2例、脊柱血液系统恶性肿瘤4例、转移瘤12例。在"C"型臂X线机下定位后通过扩张导管建立脊柱内镜通道,在内镜下剥离软组织以建立人工腔隙,随后清除脊柱内镜技术所依赖的生理盐水介质,采用通道技术进行后路减压、肿瘤刮除。对比术前及术后1个月的Frankel分级及截瘫指数评价神经功能改善情况,视觉模拟评分(visual analogue scale,VAS)评估疼痛症状改善情况,随访评估患者手术并发症及肿瘤学结果。结果18例均顺利完成手术,手术时间为(240.3±80.2)min(范围135~420 min),术中出血量为200.0(172.5,350.0)ml,术后引流量为(131.4±69.5)ml(范围5~320 ml),术后住院时间为6.0(4.0,10.25)d。术前Frankel分级A级2例、B级1例、C级3例、D级5例、E级7例,术后Frankel分级B级1例、D级6例、E级11例,1例由E级降为D级,余17例均有改善,手术前后的差异有统计学意义(Z=2.812,P=0.005)。截瘫指数由术前的1.5(0,3.0)降至术后的0(0,1.25),差异有统计学意义(Z=-2.599,P=0.009)。术前VAS为5.5(4.0,7.0)分,术后第1天降至1.5(1.0,2.25)分、术后1个月降至1.0(0,1)分、术后3个月降至0(0,1)分,差异有统计学意义(χ^(2)=44.641,P<0.001),术后各时间点VAS与术前的差异均有统计学意义(P<0.05);术后3个月VAS平均改善率为91.2%(范围75%~100%)。18例随访时间为(7.6±6.2)个月(范围1.2~15.1个月),无一例出现围手术期并发症;至末次随访未发现手术部位局部肿瘤复发,1例转移瘤患者术后3.2个月因肺部肿瘤进展发生呼吸衰竭而死亡。18例患者的生存期为13.3[95%CI(11.5,15.0)]个月,16例脊柱转移�ObjectiveTo explore the effect and safety of endoscopic tubular musculoskeletal tumor surgery(ETMS)technology in spinal tumors.MethodsClinical data were retrospectively collected from 18 spinal tumor patients who were treated with ETMS technology at Tianjin Medical University Cancer Institute and Hospital(n=16)or the Affiliated Hospital of Qingdao University(n=2)from November 2022 to December 2023.The total cohort included 11 males and 7 females,with the age at 60.3±8.6 years(range of 41-76).Two cases were diagnosed with benign tumors,four patients were diagnosed with spinal hematologic malignancies while other 12 cases were patients with spinal metastases.After localization under the C-arm X-ray machine,the spinal endoscopic channel is established using dilators.Soft tissue is dissected under endoscopic guidance to create an artificial cavity.Subsequently,the saline medium relied upon by the spinal endoscopic technique is removed,and posterior decompression and tumor curettage are performed using tubular techniques.Frankel grade classification and paraplegia index were used to evaluate the improvement of postoperative function and the VAS score was performed in pain scoring.The surgical complications and tumor evaluation were observed by postoperative outpatient and telephone follow-up.ResultsThe ETMS technology was successfully completed in all 18 patients with the mean operation time of 240.3±80.2 min.The median of intraoperative bleeding was 200.0(172.5,350.0)ml and the mean postoperative drainage was 131.4±69.5 ml.The median value of postoperative hospitalization days was 6.0(4.0,10.25)d.The paraplegia index decreased from 1.5(0,3.0)preoperatively to 0(0,1.25)postoperatively(Z=-2.599,P=0.009).All the patients presented an improvement in Frankel grading after surgery except for one patient(downgrading from grade E to grade D).There was significantly difference in Frankel grading between preoperative and postoperative groups(Z=2.812,P=0.005).The median value of preoperative VAS score was up to 5.5(4.0,7.0)w

关 键 词：内镜通道肌骨系统肿瘤外科 脊柱肿瘤 单侧双通道内镜 通道脊柱外科 

分 类 号：R738.1[医药卫生—肿瘤]