蘇保 唐可 權正學

摘要:目的 ?探討改良后路全脊椎整塊切除術治療胸腰椎腫瘤的臨床療效。方法 ?回顧性分析2014年1月~2017年7月我科19例診斷為原發或轉移單發胸腰椎腫瘤患者的臨床資料,均行改良后路全脊椎整塊切除術,分析手術情況以及術前、術后1周、術后6個月患者局部疼痛和神經功能恢復情況。結果 ?所有患者均行后路全脊椎整塊切除術手術1期完整切除腫瘤,術中無脊髓、神經根意外損傷。術中出血量300~2200 ml,平均術中出血量(830.53±430.36)ml;手術時間195~374 min,平均手術時間(290.42±44.64)min;術中輸血量0~800 ml,平均術中輸血量(342.11±296.86)ml。術前VAS評分(5.68±1.57)分,術后7 d VAS評分(1.79±0.86)分,術后6月VAS評分(1.11±0.46)分,術前與術后VAS評分比較,差異有統計學意義(P<0.05)。術后隨訪6個月,1例ASIA B級神經功能患者術后恢復為D級,1例ASIA C級神經功能患者術后恢復為D級,5例ASIA D級神經功能患者術后恢復為E級,其余12例ASIA E級神經功能患者術后仍為E級。結論 ?對于原發或轉移單發胸腰椎腫瘤患者,改良全脊椎整塊切除術是治療胸腰椎單發腫瘤可靠和有效的方式,術后患者疼痛緩解明顯,出血量較少。
關鍵詞:胸腰椎腫瘤;改良全脊椎整塊切除;后路;手術技巧
中圖分類號:R738.1 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻標識碼:A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI:10.3969/j.issn.1006-1959.2020.17.033
文章編號:1006-1959(2020)17-0112-05
Abstract:Objective ?To investigate the clinical effect of modified posterior total spinal resection for thoracolumbar tumors.Methods ?The clinical data of 19 cases diagnosed as primary or metastatic thoracolumbar tumors in our department from January 2014~July 2017 were retrospectively analyzed,all underwent modified posterior total spinal resection,the operation and the recovery of local pain and nerve function were analyzed before,1 week after operation and 6 months after operation.Results ?All patients underwent posterior total spinal surgery, stage 1 complete resection,there was no accidental injury of spinal cord and nerve root during operation. intraoperative bleeding 300~2200 ml,mean intraoperative bleeding (830.53±430.36) ml;operation time 195~374 min, mean operating time (290.42±44.64) min;intraoperative blood transfusion 0~,800 ml,mean intraoperative blood transfusion (342.11±296.86) ml. Preoperative VAS score (5.68±1.57), 7 d VAS after surgery (1.79±0.86),six months after surgery VAS score (1.11±0.46),comparison of preoperative and postoperative VAS scores,the difference was statistically significant (P<0.05).6 months after surgery,1 patient with grade ASIA B neurological function recovered to grade D,1 patient with grade ASIA C neurological function recovered to grade D, the 5 patients with grade ASIA D neurological function recovered to grade E,the remaining 12 patients with grade ASIA E neurological function were still grade E after operation.Conclusion ?For patients with primary or metastatic single thoracolumbar tumors, modified whole spine resection was a reliable and effective method for treating single thoracic and lumbar tumors,postoperative pain relief was obvious,the amount of bleeding was less.
Key words:thoracolumbar tumors;Modified whole spine resection;Posterior approach;Surgical techniques
隨著人口老齡化進程的加快和腫瘤診治水平的不斷提高,脊柱腫瘤患者逐年增多。目前,手術切除仍然是脊柱腫瘤最重要且最有效的治療方案[1]。但由于脊柱解剖結構復雜且毗鄰脊髓、神經、血管等重要結構,其外科切除難度較大、風險較高。以往多采用次全切除或分塊切除的方式,容易造成腫瘤種植、播散,局部復發率也居高不下[2]。近年來,隨著脊柱外科技術的不斷進步、脊柱內固定與重建器械的飛速發展以及對腫瘤學認識的逐步加深,脊柱腫瘤的治療從瘤體內刮除或者部分切除逐漸向全脊椎整塊切除術(total en bloc spondylectomy,TES)過渡,臨床療效也得到明顯改善。全脊椎整塊切除是脊柱外科重要的操作理念,不同于傳統手術,該技術要求在腫瘤包膜外完整切除腫瘤病變,從而能有效減少腫瘤細胞的播散、復發,提高脊椎腫瘤患者的生存率,因而是目前治療脊椎腫瘤最積極、最有效的手術方式之一。……