显微外科手术联合胸腔镜切除胸椎椎管“哑铃”形肿瘤

Microsurgical procedure combined with thoracoscopic resection for thoracic spinal canal dumbbell-shaped tumors

研究背景椎管"哑铃"形肿瘤因向椎管内及椎旁生长,压迫脊髓,侵犯椎管、椎间孔和椎旁结构而引起相应临床症状。位于胸椎的"哑铃"形肿瘤可突入胸腔生长,引起胸膜刺激症状如胸痛、气急、咳嗽等,由于侵犯广泛而难以Ⅰ期手术完整切除,存在分期手术损伤大、并发症多等缺点,随着显微外科手术联合胸腔镜技术的临床应用,使手术损伤及并发症发生率极大地降低。方法与结果 4例胸椎椎管内"哑铃"形肿瘤患者中3例Ⅱ型患者先经胸腔镜切除后纵隔肿瘤,再经脊柱后正中入路行半椎板切除术,显微镜下肿瘤显露良好,完整切除肿瘤;1例Ⅲ型患者先切除椎管内肿瘤,后经胸腔镜完整切除胸腔内病灶。术后2例患者早期症状加重,6个月后好转;1例双下肢无力、胸痛、咳嗽症状明显改善;1例干咳消失。随访期间无一例出现严重并发症或死亡,MRI检查显示肿瘤完整切除、无复发。结论经脊柱后正中入路行半椎板切除联合胸腔镜切除胸椎椎管内肿瘤具有创伤小、并发症少、疗效佳、患者恢复快等优点,可以作为治疗胸椎椎管"哑铃"形肿瘤的首选外科手术方式。

Background Spinal canal dumbbell shaped tumor growing to spinal canal and paravertebral, may compress the spinal cord and invade the spinal canal, intervertebral foramen and spinal structures, and cause clinical symptoms. The dumbbell shaped tumor in the thoracic vertebrae can penetrate thorax to cause pleural irritation symptoms, such as chest pain, short breath, cough and so on. As the microsurgical technique and video assisted thoracoscopic surgery can remarkably reduce the harm, retrospective analysis was performed in order to explore the combined treatment of microsurgical proceduse and thoracoscopic resection for spinal canal dumbbell shaped tumor and to summarize the surgical experience. Methods and Results There were 4 cases with thoracic spinal canal dumbbell shaped tumors, among them 3 were typeⅡand one was typeⅢ. In the surgery, 3 patients with typeⅡ underwent posterior mediastinal tumor resection under thoracoscope, and then underwent hemilaminectomy through posterior median approach. Under microscope, the tumors were entirely excised with excellent exporsure. The patient with type Ⅲ was firstly subjected to spinal canal tumor excision, and then entirely excisied intrathoracic tumor under thoracoscope. In 2 cases, the uncommon feelings became worse after surgery, but became better after half a year. In one case, the weakness of two legs, chest pain and cough were remarkably relieved, and in one case dry cough obliterated. During the follow up period, there was no serious complication or death, and MRI revealed that the tumors were entirely excised without relapse. Conclusion The posterior median hemilaminectomy combined with video assisted thoracoscopic surgery totreat spinal canal dumbbell shaped tumors has following advantages: small trauma, few complication, good effectiveness and rapid recovery, which can be used as preferred treatment for spinal canal dumbbell shaped tumor.