胸椎管肿瘤手术入路新选择:微通道锁孔入路

A New Approach for Thoracic Intraspinal Tumors:Microchannel Keyhole Approach

目的探讨微通道锁孔入路切除胸椎管肿瘤的可行性。方法回顾性分析2017年2月~2020年3月49例胸椎管肿瘤资料,男29例,女20例。均为2个节段以内的胸椎管髓外肿瘤,包括硬膜外肿瘤6例,硬膜内外肿瘤3例,髓外硬膜下肿瘤40例(其中脊髓腹侧肿瘤7例)。长径0.5~2.7 cm,平均1.3 cm。术中仅剥离肿瘤侧椎旁肌肉,导入微通道,切开肿瘤侧半椎板,肌肉剥离和椎板切开范围根据肿瘤大小个体化确定,必要时可潜行切除棘突根部或(和)切除小关节内侧1/4,显微手术切除肿瘤。结果微通道下半椎板入路9例,半椎板入路+棘突根部潜行切除29例,半椎板入路+棘突根部潜行切除+小关节内侧1/4切除11例。肿瘤均获全切除。手术时间80~135 min,平均96.4 min;术后3~8 d出院,平均5.5 d。术后病理为神经鞘瘤27例,脊膜瘤16例,肠源性囊肿3例,单纯囊肿1例,皮样囊肿/表皮样囊肿2例。术后3例节段性感觉减退,2例下肢肌力减退。术后随访3~36个月,平均15.4月。5例症状加重者均恢复正常,无脊柱畸形,无肿瘤复发或残留。脊髓功能均为McCormickⅠ级。结论2个节段以内的胸椎管髓外肿瘤(包括部分脊髓腹侧肿瘤)可通过个体化微通道技术全切,有利于保持胸椎稳定性。

Objective To investigate the feasibility of microchannel keyhole approach in excision of thoracic intraspinal tumors.Methods Clinical data of 49 patients(including 29 males and 20 females)with thoracic intraspinal tumors from February 2017 to March 2020 were retrospectively analyzed.There were 6 cases of extradural tumor,3 cases of extra-and intradural tumor and 40 cases of subdural extramedullary tumor(including 7 cases of ventral spinal tumor).All of them were extramedullary tumors within 2 segments.The tumors were 0.5-2.7 cm in long diameter(mean,1.3 cm).During the operation,only the paravertebral muscles of the tumor side were stripped,and then the microchannel was introduced to cut the hemi lamina.The scope of muscle dissection and laminectomy was individually determined according to the size of the tumor.If necessary,the spinous process root or(and)the medial 1/4 of the facet joint could be removed.The tumors were microsurgically resected.Results Hemilaminectomy approach was applied in 9 tumors,hemilaminectomy approach combined with underlying cut of spinous process root was applied in 29 tumors,and hemilaminectomy approach combined with underlying cut of spinous process root and facetectomy of medial 1/4 facet was applied in 11 tumors.All of the 49 neoplasms were radically excised.The duration of surgery was 80-135 minutes,with a mean of 96.4 minutes.The postoperative hospital stay was 3-8 days,with an average of 5.5 days.Pathology consisited of 27 cases of schwannomas,16 cases of meningiomas,3 cases of enterogenous cysts,1 case of simple cyst and 2 cases of drermoid/epidermoid cysts.No neurological dysfunction occurred except segmental hypoesthesia in 3 cases and weakness of lower extremity in 2 cases.The follow-up period ranged from 3 to 36 months with an average of 15.4 months.All of the 5 patients with new onset symptom returned to normal.There was no spinal deformity,recurrence or residual of tumor.The spinal cord function was McCormick gradeⅠ.Conclusion The thoracic intraspinal tumors up to two centrums(including the ventral spinal tumors)can be radically excised through individualized microchannel keyhole approaches which is benefical to maintain the stability of thoracic spine.