一期手术治疗胸、腰椎侵袭性肿瘤的临床疗效分析

目的对胸、腰椎侵袭性肿瘤一期手术治疗进行临床疗效分析。方法回顾性分析我院自2002年3月-2007年3月收治的40例胸、腰椎侵袭性肿瘤患者的病历资料，其中骨髓瘤4例，骨巨细胞瘤9例，骨转移瘤27例。手术切除方案：40例患者中椎体切除术11例，一期后正中入路或前、后联合入路全脊椎切除术6例。术后患者常规进行相应的放疗和／或化疗。结果36例（90％）患者术后腰背部疼痛症状减轻或消失，20例（50％）患者术后神经功能得到改善。本组病例术中、术后均无手术相关的严重并发症发生，全脊椎切除的6例患者截至最近随访时，未发现肿瘤复发，植骨融合满意，内固定稳定。结论胸、腰椎侵袭性肿瘤的一期手术治疗，特别是全脊椎切除术是治疗侵袭性脊柱肿瘤的有效外科手段。

Surgical treatment for thoracic and lumbar invasive vertebral tumors of the first stage

Objective Clinically analyze the effect of the surgical treatment of thoracic and lumbar invasive tumors of the first stage. Methods The clinic records of 40 patients with vertebral invasive tumors of thoracic and lumbar spine who underwent surgical treatment had been reviewed retrospectively from March 2002 to March 2007.Among the 40 patients,4 myeloma,9 giant cell tumor,and 27 metastasis.11 out of 40 patients had had somectomy,6 patients had total spondylectomy through posterior procedure alone or one-stage antero-posterior combined procedure.All the patients had received radiotherapy and/or chemotherapy post-operation routinely.Results Remarkable pain relief after surgery were achieved in 36 patients(90%).Neurological involvement was improved in 20 patients(50%) post-operation.No serious operation-relative complications occurred in these patients.No recurrence case was found in the total spondylectomy patients at the latest follow up,and more with good graft and instrument.Conclusions The surgical strategy with one-stage vertebral excision,especially total spondylectomy,has been proved to be one of the most effective surgical therapies for thoracic and lumbar invasive tumors.