摘要
目的:探讨前方入路行上胸椎肿瘤切除、椎体重建、钛板内固定的技术及方法,分析手术治疗效果及相关并发症.方法:2004年6月~2011年7月我科收治上胸椎(T1~T4)转移瘤患者17例,其中男6例,女11例,年龄55.17±7.3岁(47~68岁).术前神经功能按Frankel分级:B级3例,C级4例,D级8例,E级2例.肿瘤位置;T1 7例,T25例,T3 3例,T42例.按Tokuhashi脊柱转移瘤评分系统评分为9~12分;根据WBB分区理论肿瘤病灶位于4~9区.对于T1椎体病灶患者采用低位下颈椎前方入路;对于T2~T4椎体病灶患者采用前方劈开胸骨经头臂干外侧间隙入路.结果:所有患者均能很好耐受手术,低位下颈椎前方入路手术时间为94.1±5.0min (90~102min),出血量为186.6±100.2ml (100~400ml);前方劈开胸骨经头臂干外侧间隙入路手术时间为121.0±16.5(100~150min),出血量为352.0±134.4ml(220~600ml).术后病理学检查:6例来源于肺癌,5例来源于乳腺癌,2例来源于甲状腺癌,2例来源于胃肠道癌,2例来源不明.术后2例前方劈开胸骨经头臂干外侧间隙入路手术患者出现肺部感染、肺不张,经对症治疗后治愈.3例(其中1例为低位下颈椎前方入路手术患者)出现喉返神经牵拉伤致一过性声音嘶哑,术后1个月内声音恢复正常.随访19.7±9.8个月(6~48个月),9例患者神经功能有不同程度改善,其中3例Frankel分级B级患者2例改善为E级,1例改善为D级;4例C级2例改善到E级,2例改善到D级;2例D级患者改善到E级.5例患者在术后6~14个月因多处转移、全身衰竭死亡.结论:前方入路是治疗上胸椎转移瘤可供选择的有效入路,该入路可以充分显露前方椎体病变,有效切除病灶,彻底解除来自脊髓前方的压迫,改善患者症状.
Objectives: To discuss the techniques and outcomes of anterior approach for metastasis resection and reconstruction with titanium plate for upper thoracic vertebral tumor. Methods: From June 2004 to July 2011, there were 6 males and 11 females with the average age of 55.1±7.3 years(range, 47-68 years) with the upper thoracic(T1-T4) metastatic tumor underwent anterior resection and fixation. Their neurological func- tion was assessed by Frankel classification as following, 3 cases with grade B, 4 cases with grade C, 8 cases with grade D and 2 cases with grade E. The tumors located at T1 in 7 cases, T2 in 5 cases, T3 in 3 cases, T4 in 2 cases. Tokuhashi scoring system of 17 cases ranged from 9 to 12 points. The tumors located in the vertebral body of sectors 4-9 based on the WBB staging system. For T1 lesion, low anterior cervical ap- proach was used, and for T2-T4 lesion, anterior transsternal approach of outside window of brachiocephalic artery was used. Results All patients survived the surgery, the operation time of anterior cervical approach was 90-102min(average: 94.1±5.0min), blood loss was 100-400ml(average: 186.6±100.2ml); the operation time of anterior transsternal approach outside window of brachiocephalic artery was 100-150min (average: 121.0± 16.5min), blood loss was 220-600ml (average: 352.0~134.4ml). Pathological examination revealed metastatic lung cancer in 6 patients, metastatic breast cancer in 5 patients, metastatic thyroid carcinoma in 2 patients, metastatic gastrointestinal cancer in 2 patients and uncertainly metastatic tumor in 2 patients. Pneumonia and atelectasis occurred in 2 patients and recovered well after proper treatment; 3 patients appeared transienthoarseness and returned to normal 1 month later. The mean follow-up was 19.7_±9.8 months(range, 6 to 48 months). Neurological function improved in 9 cases, 2 patients improved from grade B to E, 1 patient im- proved from grade B to grade D; 2 patients in grade C improved to grade E, 2 patients in grade C improved to grade D and 2 patients in grade D improved to grade E. 5 patients died of systemic failure due to multi- ple metastases at 6-14 months. Conclusions: The anterior approach is reliable for thoracic spinal metastasis, which is superior for sufilcient exposure and removal of vertebral defects.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2015年第3期218-224,共7页
Chinese Journal of Spine and Spinal Cord
关键词
转移瘤
上胸椎
前路
内固定
Metastatic tumor
Anterior
Upper thoracic vertebrae
Internal fixation