前外侧腹膜后入路与后正中入路切除腰椎内外哑铃型肿瘤的疗效比较  

A comparison of the surgical effects of lumbar spinal dumbbell-type tumor resecting via anterolateral retroperitoneal approach and posterior median approach

作　　者：孔繁轩 史铁钧 顾建文 王涛[1] 谭荣 孙移坤 时全星 李楠[1] 王培新[1] KONG Fanxuan;SHI Tiejun;GU Jianwen;WANG Tao;Tan Rong;SUN Yikun;SHI Quanxing;LI Nan;WANG Peixin(Department of Neurosurgery,Ninth Medical Center,Chinese PLA General Hospital,Beijing 100101,China;Second Department of Spine Surgery,Ninth Medical Center,Chinese PLA General Hospital,Beijing 100101,China)

机构地区：[1]解放军总医院第九医学中心神经外科,北京100101 [2]解放军总医院第九医学中心脊柱二科,北京100101

出　　处：《中华神经外科疾病研究杂志》2025年第1期32-37,共6页Chinese Journal of Neurosurgical Disease Research

基　　金：解放军总医院第九医学中心学科助推计划“神经外科脊髓脊柱亚专业平台建设”,项目编号(21XK0112)。

摘　　要：目的比较经前外侧腹膜后入路与后正中入路手术切除椎管内外哑铃型肿瘤的疗效,为该类型肿瘤的手术入路提供选择方案。方法回顾性分析自2010年以来解放军总医院第九医学中心收治的腰椎管内外哑铃型肿瘤病例,并将其分为前外侧组(采用前外侧腹膜后入路)和后正中组(采取后正中入路)。对10年来两组共收治的25例患者的术前基本情况、腰椎日本骨科协会(Japanese Orthopaedic Association,JOA)评分、术后JOA评分及术后并发症等进行统计分析。结果前外侧组和后正中组术前腰椎JOA评分无显著差异;两种入路方式术后3个月的改善率比较无显著差异(P=0.887>0.05)。前外侧组术后脑脊液漏较后正中组少,但样本量过小无法进行统计比对。结论依据哑铃型肿瘤椎管外部分的体积和形状,将其分为3型,并根据不同分型指导入路方式。Ⅰ型,肿瘤的椎管外部分体积≤椎管内部分,建议采用后正中入路;Ⅱ型,椎管外肿瘤长轴平行于或近似平行于脊柱轴线,涉及多个阶段,应采用旁正中入路;Ⅲ型,椎管外肿瘤体积>椎管内部分,长短轴长度近似或呈不规则形,其中Ⅲb型为椎管外肿瘤部分的外侧与中线的距离小于4 cm,可使用后正中入路,大于4 cm为Ⅲa型,可采用前外侧腹膜后入路。Objective To compare the therapeutic efficacy of surgical resection of dumbbelltype tumors inside and outside the spinal canal via the anterolateral retroperitoneal approach and posterior median approach so as to provide a new choice of surgical approaches for this type of tumor.Methods Retrospective analysis of 25 patients of dumbbell-type tumors inside and outside the lumbar spine treated at the Ninth Medical Center of the PLA General Hospital since 2010 was made by dividing them into the anterior lateral group(using the anterolateral retroperitoneal approach)and the posterior median group(using the posterior median approach).Statistical analysis was conducted on the preoperative basic information,lumbar spine JOA score,postoperative JOA score,and postoperative complications.Results There was no significant difference in preoperative lumbar JOA score between the two groups.There was no significant difference in the improvement rate between the two approaches 3 months after surgery(P=0.887>0.05).Postoperative cerebrospinal fluid leakage in the anterolateral group was less than that in the median group,but the sample size was too small for statistical comparison.Conclusions According to the volume and shape of the outer part of the spinal canal,dumbbelltype tumor can be divided into 3 types for treatment.For TypeⅠ,as the volume of the tumor's outer part of the spinal canal is less than or equal to that of the spinal canal,the posterior median approach is recommended.For TypeⅡ,as the long axis of the tumor outside the spinal canal is parallel to or nearly parallel to the spinal axis,which involves multiple stages,the para-median approach should be adopted.For TypeⅢ,as the volume of the tumor outside the spinal canal is larger than the inside part of the spinal canal,and the length of the long and short axes is approximately equal or the tumor shape is irregular,two different approaches can be taken,i.e.,for TypeⅢb(the distance between the lateral line of the tumor outside the spinal canal and the midline o

关 键 词：腰椎哑铃型肿瘤 前外侧腹膜后入路 后正中入路 

分 类 号：R739.42[医药卫生—肿瘤]