原发椎管内血管外皮细胞瘤临床分析

Clinical research of primary intraspinal hemangiopericytoma

目的探讨治疗原发椎管内血管外皮细胞瘤的有效手段。方法回顾性分析23例原发椎管内血管外皮细胞瘤的临床表现、影像学特征、治疗方法及预后。结果肿瘤次全切除11例,次全切除加放疗4例,全部切除5例,全部切除加放疗3例。对2例肿瘤全部切除的病人同时进行了内固定。随访19例,肿瘤复发率为68%(13/19),转移率为21%(4/19)。结论整块切除肿瘤和受累的硬脊膜,可减少术中出血和术后复发。若病变较大需分块切除,术前应先栓塞。未能全切的病人需辅助放疗。椎体或椎弓根破坏明显的病人尽可能同时行内固定术。肿瘤起源于硬脊膜的病人预后较好。术后长期随访是必要的。

Objective To investigate the effective means of treatment for primary intraspinal hemangiopericytoma. Methods The clinical presentation, imaging features, treatment and prognosis of 23 cases of intraspinal hemangiopericytoma, 14 males and 9 females, aged 39. 1 （ 14-65 ） , were analyzed retrospectively. Results Subtotal resection was performed on 11 cases, subtotal resection and radiotherapy on 4 cases, total resection on 5 cases, and total resection and radiotherapy on 3 cases. Spinal stabilization was conducted on 2 cases after total resection with severe damage of the vertebral body or pedicle of vertebral arch. Nineteen cases were followed up for 3.8 yeas （6 months-10 years）. The recurrence rate was 68% and the metastasis rate was 21%. Condusion Primary intraspinal hemangiopericytoma should be resected en bloc with neighboring dura mater to reduce blood loss and recurrence. Resection of large lesions may be safer after preoperative embelization. The patients undergoing subtotal resection need adjuvant radiotherapy. The patients with evident spinal involvement may benefit from spinal stabilization. Lesions arising from dural mater have better prognosis. Postoperative long-term foUow-up is necessary.