前路内镜辅助后路改良一期全脊柱整块切除脊柱重建术治疗胸椎肿瘤

Anterior endoscopy combined with modified one-stage posterior total en bloc spondylectomy and spinal reconstruction in the treatment of thoracic spine tumors

目的探讨前路内镜辅助后路改良一期全脊柱整块切除脊柱重建术治疗胸椎肿瘤的疗效。方法采用经前路内镜辅助联合后路改良全脊椎整块切除、脊椎重建术治疗4例胸椎肿瘤患者。记录手术时间、术中出血量、输血量,观察局部疼痛和脊髓功能恢复以及肿瘤复发、植骨融合、脊柱稳定情况。结果手术时间250~295(269.3±39.8)min,术中出血量850~1 550(1 232.5±37.9)ml,输血量300~1 000(675±100)ml。4例均获得随访,时间3~24个月。1例发生胸腔积液,经引流抗感染后好转。患者局部疼痛和脊髓功能均有不同程度改善。1例肺癌转移患者术后3个月因肺癌复发死亡;其他患者术后3、6、12个月复查未见脊柱肿瘤复发,植骨融合良好,无钛网移位及脊柱失稳,无断钉、断棒现象。结论前路内镜辅助后路改良一期全脊柱整块切除术能提高胸椎肿瘤病灶切除率、减少术中出血量及输血量,手术安全,效果较好。

Objective To investigate the clinical efficacy of anterior endoscopy combined with modified one-stage posterior total en bloc spondylectomy for the treatment of thoracic spine tumors.Methods Four patients with thoracic spine tumors were treated by anterior endoscopy combined with modified posterior total en bloc spondylectomy.The operation time, intraoperative blood loss, blood transfusion, recovery of local pain and spinal cord functional , and tumor local recurrence , bone graft and fusion , spinal stability were observed.Results The operation time was 250~295（269.3 ±39.8）min.The volume of blood loss and transfusion was 850~1550（1232.5 ±37.9）ml, 300~1000（675 ±100）ml,respectively.Four patients were followed up for 3~24 months.Pleural effusion in 1 case was improved by drainage and antiinflammatory.Four patients local pain and spinal cord founction improved , lung cancer recurrence and death happened in a patient with lung cancer metastasis at 3 months after surgery.At 3,6,12 months postoperation , postoperative follow-up showed no recurrence or metastasis , good bone fusion , without titanium mesh displacement and spinal instability , or screw-rods breakdown.Conclusions Anterior endoscopy combined with modified one-stage posterior total en bloc spondylectomy can improve lesion resection , which not only reduce intraoperative bleeding and blood transfusion , but also get good effects.