颈部椎管内外肿瘤的外科治疗

Surgical Treatment of the Cervical Intra-and Extraspinal Tumors

根据肿瘤与椎间孔的关系将 2 7例颈部椎管内外肿瘤分为 3种类型 ,并采取不同的手术方法 :Ⅰ型 ( 1 3例 ) :瘤体主要在椎管内 ,向椎间孔内生长不超过 1cm ,椎间孔轻微扩大 ,采用后正中切口手术。Ⅱ型 ( 4例 ) :瘤主体在椎管外 ,少部分长入椎间孔 ;采用颈部入路手术。Ⅲ型 ( 1 0例 ) :肿瘤在椎管内外都较大 ,椎间孔明显扩大 ;采用颈部和后正中入路 ,分 2期切除肿瘤。结果 :全切肿瘤 2 5例 ,近全切除 2例。其中 2 3例随访 6～ 79月 ,2 2例恢复工作。提示 :对颈部椎管内外肿瘤 ,应分型选择术式 ,以利于全切肿瘤 ,并利于维持脊柱稳定性和椎动脉保护。

Although the cervical intraspinal tumors have been long successfully removed, the cervical intra-and extraspinal tumors have not been viewed with optimism by surgeons. According to the relationship between tumors to intrvertebral foramen,the author proposed a classificaton system (three types) for 27 cases as a means to choice the different surgical method. Type Ⅰ (13 cases): The tumors were mainly located in vertebral canal, and limited in 1cm form intervertebral foramen that gently magnified. The posterior midline applied for type Ⅰ tumor. Type Ⅱ(4 cases): The antercervical accesses were employed to excise the tumors mainly located in extravertebral canal, a little portion in vertebral canal. Type Ⅲ (10 cases): Patients with dumbbell tumor had a larger intervertebral foramen. We performed two-stage combined surgery through the antercervical and the posterior midline route to excise the tumors. The results were total resection (25 cases), nearly total resection (2 cases). 23 cases patients could regain to work during follow-up interval of 6～79 months. For cervical intra-and extraspinal tumors, the different surgical approach should be applied to facilitate total resection, and can maintain the stability of spine and protect vertebral artery.