后路一期整块全脊椎切除治疗胸腰椎肿瘤

目的:总结后路一期整块全脊椎切除的手术经验、并发症和对神经功能的影响。方法:2006年8月至2007年9月对9例脊柱肿瘤患者进行后路一期整块全脊椎切除术,病理诊断包括4例骨巨细胞瘤,1例尤文肉瘤,1例孤立性浆细胞瘤,3例孤立性骨转移癌。8例患者肿瘤位于胸椎,1例位于腰椎。4例患者术前接受了病椎的选择性节段动脉栓塞。所有病例术前均根据Tomita脊柱肿瘤外科分期进行评估,2例患者为间室内,7例为间室外。对切除的肿瘤标本进行外科边界检查。采用Frankel分级对神经功能进行评价。结果:平均术中失血量5800ml,平均手术时间291min。2例患者获得广泛边界,其他为边缘性边界。1例术后血肿形成,1例脑脊液漏致胸腔积液,1例血肿形成合并脑脊液漏。随访14～36个月,平均25.8个月,在随访期内肿瘤无复发,2例转移癌及1例尤文肉瘤患者带瘤生存,1例转移癌死亡,4例无瘤生存。术后所有病例神经功能均获得改善或保持原有水平。结论:对具有适应证的胸腰椎肿瘤患者进行后路一期整块全脊椎切除手术可以获得满意的局部控制和功能恢复,但仍需要进一步随访并提高技术,减少合并症的发生。

One staged posterior total en bloc spondylectomy for thoracal and lumbar tumors

Objective :To ascertain the early ontological outcomes,complications and neurological function of total en bloc spondylectomy(TES),meanwhile,summarise surgical experience of this complicated surgical tech-nique.Method:Between August 2006 and September 2007,nine patients with spinal tumors underwent TES in our institute.The pathological diagnosis included four giant cell tumors,one Ewing's sarcoma,one plasmacy-toms,and three solitary metastatic bone tumors.Among them,eight cases located in the thoracic vertebrae and one in lumbar spine.According to the Tomita surgical classification of vertebral tumors,the anatomic sites of two tumors were considered as intracompartmental and seven tumors as extracompartmental.To reduce the blood loss during TES,four patients received selective segmental artery embolization before the procedure.The resected specimens were checked carefully to mark their surgical margin.The neurological function was deter-mined by Frankel classification.Result:The mean blood loss during TES was 5800ml,and the mean operation time was 291min.Complications including postoperative hematoma,pleural effusion,and dural leakage occurred in three patients.The mean follow-up time was 25.8 months,two patients had wide margin,the others had marginal margin.No patients experienced local recurrence in our short follow-up period.Two patients with metastactic tumor and one with Ewing's sarcoma were alive,and one with metastactic tumor died.The postop-erative neurological functions were improved or maintained in all patients after TES.Conclusion:This prelimi-nary study demonstrates that TES can provide a satisfied local control and postoperative function for those thoracal and lumbar tumors with proper indications,however more practiced surgical skills are needed for re-ducing the complication rate.