上胸椎肿瘤的手术途径及术式探讨

Surgical procedure for upper thoracic spine tumors

目的 探讨上胸椎肿瘤前路不同手术路径 ,肿瘤切除术式 ,Orion钢板或TSRH内固定术的作用。 方法 上胸椎肿瘤患者 15例 ,其中骨巨细胞瘤 5例 ,软骨肉瘤 1例 ,嗜酸性肉芽肿 1例 ,血管瘤 1例 ,骨髓瘤 1例 ,恶性淋巴瘤 1例 ,转移癌 4例 ;脊柱外科分期 :Ⅰ期 7例 ,Ⅱ期 3例 ,Ⅲ期 1例 ,Ⅳ期 4例 ;肿瘤切除方式 :囊内切除 4例 ,包膜切除 7例 ,广泛切除 4例。根据肿瘤的病理类型 ,术后给予相应的放疗或化疗。 结果 术后随访 3～ 2 0个月 ,2例术后出现声音嘶哑 ,系术中喉返神经牵拉伤所致 ,2个月后症状缓解。近期疗效均较满意 ,15例患者术后神经功能均有所改善。 1例T1转移性腺癌 (来源于化学感受器腺癌 )患者术后 16个月因全身多处转移 ,全身衰竭死亡。 1例T1～T2 骨巨细胞瘤患者囊内切除术后 8个月局部复发。 结论 应根据肿瘤的部位、性质、分期选择相应的手术途径及肿瘤切除方式 ;前路植骨、人工椎体、Orion或TSRH内固定术有利于上胸椎的重建和稳定。

Objective To investigate the ef fects of different anterior surgical approachs of upper thoracic spine, tumor excision procedure, Orion plate or TSRH fixation. Methods [ WT5”BZ]Oncologic types, surgical staging, clinical manifestation of tum ors,different operative approaches, surgical procedures and prognosis were descr ibed. In 15 patients, 5 patients had giant cell tumor, 1 chondrosarcoma, 1 an gioma, 1 eosinophilic granuloma,1 non hodykin lymphoma, 1 solitary plasmacytoma , and 4 metastases. The tumors were divided into four stages: Ⅰ stage (7 patien ts), Ⅱ stage (3), Ⅲ stage (1), Ⅳ stage (4). Four patients underwent intracaps ule excision, 7 marginal excision, and 4 wide excision. Radiotherapy and chemica l therapy were given accordingly. Results Foll ow up for 3 20 months showed transient voice hoarse due to larygeal nerve injur y in 2 patients. The symptoms of the injury disappeared in 2 months after opera tion. The neurological function after spinal cord in the 15 patients were impro ved. One patient with T 1 metastatic gland cancer originated from the chemical susceptor died from general metastasis and failure 16 months after operation. One patient with giant cell tumor recurred 8 months after intracapsule excision. Conclusions Relative operative approach and p rocedures should be selected according to the nature, location and staging of tu mors. Anterior bone graft, artificial vertebrae replacement,Orion plate or TSRH fixation are useful for reconstruction and stabilization of upper thoracic vert ebrae.