胸椎椎板截骨原位再植在胸椎椎管内肿瘤手术治疗中的应用

Thoracic laminectomy and anatomic implant in situ in the treatment of tumor in spinal canal

目的 观察通过胸椎椎板截骨原位再植治疗椎管内肿瘤的疗效。方法 自1995年8月至2003年12月对56例胸椎椎管内肿瘤实施胸椎椎板截骨原位再植、椎管内肿瘤切除术。其中男性32例,女性24例,年龄23～68岁,平均34.7岁。病变部位:T_t～T_629例,T_7～T_12 37例。病变范围:1个节段8例,2个节段21例,3个节段18例,4个节段5例,6个节段3例,7个节段1例。本组患者硬膜外肿瘤43例,硬膜内肿瘤13例。神经鞘瘤23例,脊膜瘤18例,脑室管膜瘤7例,脂肪瘤3例,囊肿3例,畸胎瘤2例。其中因肿瘤二次复发手术9例。结果 手术时间90～205min,平均137min。失血量300～1400ml,平均760ml。术后随访3～38个月,平均14个月。术后X线平片、CT、MRI观察椎板愈合时间4.5～6个月,平均5个月。术后出现脑脊液漏4例,肋间神经痛2例,术后复发9例,其中本院术后复发3例。结论 该术式安全可行,避免椎板咬骨钳咬除椎板造成椎管内的进一步占位损伤脊髓,而且缩短了手术时间。通过椎板回植恢复了脊髓所需要的椎管管性结构,减少了椎管内术后粘连,有利于二次手术。

Objective To study the treatment of the tumor in spinal canal by thoracic laminectomy and anatomic implant in situ. Methods From August 1995 to December 2003, 56 patients had undergone thoracic laminectomy and anatomic im- plant in situ for the treatment of tumor in spinal canal, including 24 female and 32 male patients. The average age was 34.7 years old (ranging from 23 to 68 years old). 29 cases were located at T_1-T_6 and 37 cases at T_7-T_(12). The affected segment was 1 in 8 cases, 2 in 21 cases, 3 in 18 cases, 4 in 5 cases, 6 in 3 cases and 7 in 1 case. This group was epidural tumor in 43 cases, subdural tumor in 13 cases, schwannoma in 23 cases, meningioma in 18 cases, ependymoma in 7 cases,lipoma in 3 cases,cyst in 3 cases and teratoma in 2 cases including 9 cases recurrence operated. Results The surgical time ranged from 90 to 205 minutes (mean 137 minutes), and the blood loss ranged from 300 to 1400ml (mean 760 ml). We found that the lamina of vertebra needed 4. 5 to 6 months (mean 5 months) to heal according to postoperative X-rays, CT and MRI. The postoperative follow-up ranged from 3 to 38 months (mean 14 months). 15 cases had postoperative complications, including cerebrospinal fluid leakage in 4 cases, postoperative recurrence in 9 cases and intercostal neuralgia in 2 cases. Conclusion The treatment of the tumor in spinal canal by thoracic laminectomy and anatomic implant in situ is safer than for- mer procedure, which can avoid the further occupation in the spinal canal and the injury of spinal cord, and shorten the surgi- cal time. It also can recover the canal structure and diminish postoperative adhesion in the spinal canal, which is used for sec- ondary operation.