颈胸段脊柱肿瘤的外科治疗

The surgical treatment of the cervicothoracic junction tumors

目的观察比较不同手术入路方法治疗颈胸段脊柱肿瘤的疗效。方法本组9例 ,共10例次。对其中4例肿瘤同时累及椎体及椎体后部结构的患者 ,选择前后路同期手术 ,经前路切除肿瘤、椎管减压及钢筋骨水泥或前路钢板固定 ,并同期行后路肿瘤切除术 ,其中1例行Luque棒固定 ;对4例肿瘤仅累及椎体者 ,选择经前路切除肿瘤、椎管减压、钢筋骨水泥固定 ;另2例肿瘤单纯累及椎体后部结构者 ,经后路行肿瘤切除和椎管减压术。术后4例骨巨细胞瘤患者辅以局部放射治疗。结果9例(10例次)患者均安全度过围手术期 ,随访2～62个月。6例术后发生并发症 ,其中1例乳糜漏 ,经纵隔引流8d ,拔除引流管而愈 ;3例出现神经受损症状(共5例次 ,3例次喉返神经、2例次膈神经) ,3个月后症状均自行消失。所有患者术后神经功能均有不同程度改善 ,随访期间7例无局部复发 ;1例T2 转移性肺癌患者14个月后死于癌细胞全身转移 ;1例C7 骨巨细胞瘤患者术后2年肿瘤复发 ,再次行前后入路联合手术 ,术后Frankel分级为D级。结论对颈胸段脊柱肿瘤的治疗应根据肿瘤所累及范围选择不同的术式。前后入路联合手术有利于彻底切除肿瘤。

Objective To report the results of sternotomy and combined anterior-posterior approach in the treatment of tumors located in the cervicothoracic junction. Methods Totally 10 cases were treated with the various surgical approach. Four patients with tumor in vertebrae and posterior elements of vertebrae underwent anterior resection, spinal cord decompression, restoration of the stabilization of vertebrae and posterior resection at one surgical setting. Four patients with tumor only in vertebrae underwent anterior resection, spinal cord decompression, and restoring of the stabilization of vertebrae. Two patients with tumor only in posterior elements of vertebrae underwent posterior resection and spinal cord decompression. Reconstruction of the resected vertebral body was performed by using Steinmann pin/polymethylmethacrylate only or combined Steinmann pin/polymethylmethacrylate and anterior plate in giant cell tumors or metastatic lung cancer or by using autografts only in benign tumor. Reconstruction of the resected posterior elements of vertebrae was performed by using Luque rod in one patient. Postoperative irradiation of the spine using standing fraction (generally 3 000 cGy in 10 doses) was administered to 4 of the 9 patients. Results All patients stood surgery well. Nine patients were followed up from 2 to 62 months. One patient had chylorrhea after operation and responded well after mediastinum drainage for 8 days. Three patients suffered from recurrent laryngeal nerve injury and two patients had phrenic nerve injury, however, the symptoms of nerve injury disappeared within three months. One patient with metastatic lung cancer died of distant metastasis 14 months later. One case of giant cell tumor underwent posterior resection recurred after 2 years and combined anterior-posterior resection and instrumentation was applied. The other seven patients had improvements of the neural symptoms. Conclusion The surgical treatment of the cervicothoracic junction tumors must be decided upon according to the types of the tumor, their locations and extensions. Combined anterior-posterior surgeries are required for adequate tumor removal, neural decompression and stabilization of the spinal column.