摘要
目的探讨全脊椎整块切除在脊柱肿瘤治疗临床应用中的适应症、安全性与疗效。方法回顾性分析我院脊柱外科于2009-2014年收治的6例行后路瘤椎全脊椎整块切除脊柱重建术的胸椎和腰椎肿瘤患者,男性3例、女性3例;年龄45-72岁（平均64岁）;T8乳腺癌转移瘤伴不全性截瘫1例,T10、L1肺癌转移瘤2例,T12原发性骨巨细胞瘤1例,T10甲状腺癌转移瘤伴不全性截瘫1例,恶性黑色素细胞瘤T8转移1例;6例患者中甲状腺癌、乳腺癌者行根治术后1年,肺癌者肺叶切除术后2年和5年,局部均无复发,除脊柱转移外未发现其他部位远处转移灶。对比观察实施手术前、后患者生活质量、疼痛评分、脊柱稳定性的改变、神经功能改变及手术后并发症发生情况。术中术后对肿瘤切缘和肿瘤切除标本均行病理检查。结果6例患者术后均获随访,随访时间12-45个月,其中2例患者分别于术后15个月、27个月死亡。其余患者至末次随访肿瘤原发灶和手术部位无复发。Frankel神经功能分级：4例患者术后恢复至E级,2例至D级,JOA评分改善率为84.5%。结论全脊椎整块切除术仍适用于脊柱原发肿瘤和孤立转移性肿瘤的治疗,并能达到脊柱恶性肿瘤边缘切除和脊髓神经根彻底减压、提高肿瘤切除率,降低复发率、延长生存期的目的。但须术前充分评估患者肿瘤原发灶性质、转移灶特点、全身状况和生存期预测,严格掌握手术适应症。
Objective To explore the indications, safety and efficacy of en bloc resection in the treatment of spinal tumors. Methods Retrospective analysis of 6 cases of spinal surgery in our hospital from 2009 to 2014 was done, the patients with thoracic and lumbar spinal tumors undergoing en bloc resection of spinal reconstruction were chosen. Among them, 3 cases for male, 3 cases for female, who aged 45 to 72 years（average 64 years old）; 1 case was T8 metastatic breast cancer, 2 cases were T10 metastatic tumor of lung cancer, 2 cases were T12 primary of giant cell tumor of bone, 1 case was T10 thyroid carcinoma complicated with incomplete paraplegia; 1 cases was malignant melanoma T8 metastasis, 6 cases were cancer at thoracic vertebra and lumbar vertebra and underwent radical surgery 1 years, 2 years and5 years after lung cancer resection,there was no local recurrence. In addition to the spinal metastasis no other parts of the distant metastasis lesions was found. The changes of life quality, pain score, spinal stability, neurological function and postoperative complications were compared between the patients before and after the operation. Intraoperative postoperative cut edge and around the tumor resection specimen pathological examination. Results 6 patients were followed up from 12 to 45 months, 2 patients were died at 15 months and 27 months after surgery. The remaining patients to the end of the tumor primary lesion and surgical site without recurrence. Frankel neural function classification： 4 patients recovered to grade E, 2 patients recovered to grade D, the improvement rate of JOA score was 84.5%.Conclusion En bloc resection is still applicable to the treatment of primary tumors of the spine and solitary and metastatic tumors, it can reach the edge of spinal malignant tumor resection and spinal nerve root complete decompression, improve tumor resection rate, reduce the recurrence rate and prolong the survival time. However, it is essential to evaluate the nature of the primary tumor in patients, the characteristics of metastasis foci, general situation and survival period were predicted, and surgical indications were strictly controlled.
出处
《新疆医学》
2016年第3期305-309,共5页
Xinjiang Medical Journal
关键词
脊柱原发肿瘤
脊柱孤立转移瘤
全脊椎切除
Primary Spinal Tumors
Spinal Solitary Metastasis
Total Spine Resection
