胸腰椎肿瘤全脊椎整块切除初步应用及手术方法改进

Total en bloc spondylectomy for tumor of the thoracolumbar spine

[目的]探讨全脊椎整块切除术(total en-bloc spondylectomy,TES)治疗脊椎肿瘤的可行性与临床价值。[方法]采用全脊椎整块切除术治疗4例原发胸腰椎脊柱肿瘤,其中行单一后路全脊椎切除3例(包括:T10单发浆细胞瘤1例,T8全脊椎血管瘤1例,和T12全脊椎血管瘤1例);行前后联合入路全脊椎切除1例(为L4神经母细胞瘤并椎旁肿块),并对标准TES手术中的截骨器械和手术技巧进行改进。[结果]所有患者术后临床症状均明显改善,未出现严重手术并发症。随访时间13～22个月,至末次随访时,所有患者均未出现局部复发和远处转移。[结论]全脊椎整块切除术一改传统分块切除脊椎肿瘤的方式,将脊椎分为前后两部分予以完整切除,被认为是目前治疗脊椎肿瘤最为积极有效地手术方法之一,而其手术方法和技巧尚待进一步改进。

[ Objective] To evaluate the possibility and clinical value of total en bloc spondylectomy for the treatment of spinal tumors. [ Method] Four cases of primary tumor of the thoracolumbar spine were treated with total en bloc spondyleetomy TES through a single posterior, approach performed in three cases （T10 solitary plasmacytoma, T8 bemangioma, and Tl2 hemangioma）, and one case through a single stage anterior and posterior combined approach （L4 neuroblastoma with paraspinal mass） . Improvements in osteotomy apparatus and surgical technique of TES were investigated. [ Result] All patients attained significant clinical improvement after surgery without any severe complications. Patients were observed for 13 to 22 months. There was no local recurrence and distal metastasis by the last follow - up. [ Conclusion] Total en bloc spondylectomy includes resection of the involved vertebra in two major blocs, rather than a piecemeal pattern. It is one of the most effective therapies for spinal tumors. Howerer, some components of TES remain to be further improved.