颈椎旁神经源性肿瘤手术入路的探讨

背景与目的：颈椎旁神经源性肿瘤多起源于脊神经背根，与颈动脉三角区的颈总动脉，颈内静脉，迷走神经及椎动脉等重要血管神经相互毗邻。其特殊的解剖位置使得手术难度增加，手术进路的选择也就显得尤为重要。本文旨存探讨颈侧手术入路对颈椎旁神经源性肿瘤切除的可行性及其治疗效果。方法：回顾性分析经颈侧入路于术治疗的从1971～2006年我院29例颈椎旁神经源性肿瘤患者的临床资料。结果：本组病例中，良性肿瘤20例，占70．37％（19／27），恶性肿瘤9例，占29．63％（8／27）。本组29例病例中，经颈侧进路切除肿瘤28例，经颈项部切门进路枕部下横切口1例。27例肿瘤全切除的病例中，经颈侧切口进路肿瘤全切除26例，其中胸锁乳突肌前缘切口12例，胸锁乳突肌后缘切口7例，颈胸切口1例，下颌角下做横切口4例，锁上弧形切口2例；经颈项部进路切除肿瘤1例。经颈侧进路肿瘤全切除26例．大部分切除2例，肿瘤全切除率为92．85％（26／28）；在肿瘤全切除病例中，有3例局部复发，1例局部复发伴双肺转移。肿瘤全切除病例的局部复发率为14．81％（4／27）。结论：颈椎旁肿瘤经颈侧切口进路手术具有术野暴露清楚，肿瘤全切除率较高等优点，应为颈椎旁肿瘤切除手术切口进路的首选。

Exploration to Surgical Approach of Cervical Paravertebral Neurogenic Tumors

BACKGROUND & OBJECTIVE:As of anatomic complex, surgical approach for cervical paravertebral tumur is crucial. This study was to explore the surgical approach and efficacy for cervical paravertebral neurogenic tumors.METHODS: The clinical data of 29 patients with cervical paravertebral neurogenic tumors treated in our hospital from 1971 to 2006 were analyzed retrospectively. RESULTS:Among these 29 patients, 20 cases were benign and 9 cases were malignant. Two surgical approaches were employed. Cervical and nuchal approach was applied in 1 case. Lateral Cervical approach was applied in 28 cases. In lateral cervical approach group,tumor was resected totally in 26 cases and partially in 2 cases. The total resection rate is 92.85%(26/28). Three cases recurred locally and 1 case recurred locally with pulmonary metastasis. The local recurrence rate was 14.81%(4/27). Among all the 29 patients, total resection was achieved in 27 cases. Exterior edge of sternocleidomastoid approach was used in 12 cases. Posterior approach of sternocleidomastoid was employed in 7 cases and a combined cervical and thoracic approach was employed in 1 case. Submandibular approach was employed in 4 cases and supraclavicular approach in 2 cases; CONCLUSIONS: The cervical lateral approach is characterized by wide operation field and high total resection rate. It is an effective approach to remove the tumor of cervical paravertebral neurogenic tumors.