CAJ | 학술논문

目的总结15例全脊椎整块切除术(totalenblocspondylectomy，TES)治疗原发性胸腰椎肿瘤的临床疗效。方法2005年1月至2013年1月，我科采用TES治疗原发性胸腰椎肿瘤15例。其中行单一后路全脊椎切除12例：T11浆细胞性骨髓瘤、L1骨肉瘤、L1浆细胞性骨髓瘤、L3组织细胞肉瘤各2例，L2骨巨细胞瘤、L2单发浆细胞瘤、L2软骨肉瘤和T7骨肉瘤各1例；行后前联合入路全脊椎切除3例：L4骨巨细胞瘤并椎旁巨大肿块2例、L4纤维肉瘤1例。15例Tomita分期为III～VI期，均有TES手术适应证。肿瘤切除后均一期脊柱重建。对所有病例进行术前、术后神经功能测评，监测术后生存情况、并发症及肿瘤复发情况。结果15例肿瘤均完整切除，平均手术时间365min，术中平均出血量3500ml。本组15例术后均获12～60个月的随访，平均29个月。除1例复发外，其他14例均未发现局部复发及远处转移且术后临床症状均明显改善。复发的1例于术后1年死亡，其余14例均无瘤生存，总生存率为93.33%。神经功能评分由术前平均(3.81±0.98)分改善至术后(4.89±0.19)分，术前、术后比较，差异有统计学意义(t＝-5.619，P＜0.05)。1例L1浆细胞性骨髓瘤者术中出现淋巴管瘘，此患者术后1年出现断棒，导致脊柱不稳。所有病例未出现脑脊液瘘及切口感染。结论对于有手术适应证的原发性胸腰椎肿瘤，行TES术方法可靠、疗效满意、复发率低，但仍须进一步随访，提高手术技术以减少并发症的发生。
목적총결15례전척추정괴절제술(totalenblocspondylectomy，TES)치료원발성흉요추종류적림상료효。방법2005년1월지2013년1월，아과채용TES치료원발성흉요추종류15례。기중행단일후로전척추절제12례：T11장세포성골수류、L1골육류、L1장세포성골수류、L3조직세포육류각2례，L2골거세포류、L2단발장세포류、L2연골육류화T7골육류각1례；행후전연합입로전척추절제3례：L4골거세포류병추방거대종괴2례、L4섬유육류1례。15례Tomita분기위III～VI기，균유TES수술괄응증。종류절제후균일기척주중건。대소유병례진행술전、술후신경공능측평，감측술후생존정황、병발증급종류복발정황。결과15례종류균완정절제，평균수술시간365min，술중평균출혈량3500ml。본조15례술후균획12～60개월적수방，평균29개월。제1례복발외，기타14례균미발현국부복발급원처전이차술후림상증상균명현개선。복발적1례우술후1년사망，기여14례균무류생존，총생존솔위93.33%。신경공능평분유술전평균(3.81±0.98)분개선지술후(4.89±0.19)분，술전、술후비교，차이유통계학의의(t＝-5.619，P＜0.05)。1례L1장세포성골수류자술중출현림파관루，차환자술후1년출현단봉，도치척주불은。소유병례미출현뇌척액루급절구감염。결론대우유수술괄응증적원발성흉요추종류，행TES술방법가고、료효만의、복발솔저，단잉수진일보수방，제고수술기술이감소병발증적발생。
Objective To investigate the curative outcomes of total en bloc spondylectomy ( TES ) in the treatment of primary thoracolumbar tumors. Methods From January 2005 to January 2013, 15 patients with primary thoracolumbar tumors underwent TES. Posterior TES was performed on 12 cases, including 2 cases of plasma cell myeloma in T11, osteosarcoma in Ll, plasma cell myeloma in Ll and histiocytic sarcoma in L3 and 1 case of giant cell tumor of bone in L2, solitary plasmacytoma in L2, chondrosarcoma in L2 and osteosarcoma in T7. TES via combined anterior and posterior approaches was performed on 3 cases, including 2 cases of giant cell tumors of bone and paraspinal huge masses in L4 and 1 case of ifbrosarcoma in L4. According to Tomita surgical classiifcation system, all the 15 patients belonged to type III-VI, among whom the TES operative indications were correct. One-stage spinal reconstruction was performed after the tumor resection. The preoperative and postoperative neurological function was evaluated, and the postoperative survival, complications and recurrence were monitored. Results Tumors were resected completely in the 15 patients. The mean operation time was 365 min, and the mean intraoperative blood loss was 3500 ml. All the patients were followed up for a mean period of 29 months ( range;12-60 months ). No local recurrence or distant metastasis was found but in 1 case. The clinical symptoms were signiifcantly improved after the surgery in all the patients. The patient had recurrence died at 1 year after the operation, and the other 14 patients were alive without tumors. The total survival rate was 93.33%. The neurological function scores were improved from ( 3.81±0.98 ) points preoperatively to ( 4.89±0.19 ) points postoperatively, and the differences between them were statistically signiifcant ( t=-5.619, P<0.05 ). Lymphatic ifstula was detected during the operation in 1 patient with plasma cell myeloma in Ll, and rod fracture and spinal instability occurred to this patient at 1 year after the operation. No cerebrospinal lfuid ifstula or incision infection was found in all the patients. Conclusions TES is a reliable technique in the treatment of primary thoracolumbar tumors of surgical indications, with the advantages of satisfactory outcomes and low recurrence rate. In order to reduce complications, the patients should be followed up for a longer period and the technique should be further improved.