胸腰椎脊索瘤的临床特点和治疗分析

Clinical character and cure analysis of thoracolumbar vertebral chordoma

目的:探讨胸、腰椎脊索瘤的临床特点和治疗方法.方法:对7例胸、腰椎脊索瘤患者的临床资料进行总结,根据WBB分期,实施椎体或全脊椎切除,其中囊内切除3例、扩大切除4例.结果:术后5例患者症状完全消失.1例T7、T8脊索瘤患者出现切口下缘顽固性疼痛,封闭后疼痛减轻.1例L1～L3脊索瘤全瘫患者,双下肢肌力恢复至2级.病理检查镜下均可见'印章样细胞环'和'合胞体'.术后平均随访5.2年,局部复发1例,无远处转移.结论:胸腰椎脊索瘤相对少见,临床表现不典型,容易误诊.'印章样细胞环'和'合胞体'是胸、腰椎脊索瘤的典型病理表现.全脊椎切除肿瘤能降低局部复发率.

Objective:To study the character and treatment method of thoracolumbar vertebral chordoma.Method:Clinical data of 7 cases were reviewd.On the basis of WBB stage,total centrum resection or total spondylectomy(TS) was performed,excising with intralesion in 3 cases or wide margin in 4 cases.Result:The symptom of 5 cases was disappeared after operation.One patient with T7?T8 chordoma had pertinacious pain under incision and the pain was alleviated after local injection.The strength of lower limb increases reach Ⅱ level in one caes suffering from L1~L3 chordoma and paralysis.Seal cell ring and syncytium was seen among all cases.Follow-up average 5.2 years,one case local recurred in 6.4 year post-operation and no evidence of metastasis.Conclusion:Thoracolumbar vertebral chordoma is few in clinic,which is easily misdiagnosed.Seal cell ring and syncytium are typical pathological phenomena.Total spondylectomy declines local recurrence.