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目的探讨上颈段哑铃形肿瘤的外科治疗策略及预后。方法回顾2000年1月至2009年12月收治的46例上颈段哑铃形肿瘤患者,分析其临床特点、外科分期、手术入路、切除方法、内固定重建技术及疗效。肿瘤性质包括神经鞘瘤33例,神经纤维瘤9例,恶性神经鞘瘤4例。依据前期设计的颈椎管哑铃形肿瘤的外科分期方法,Ⅰ期8例,Ⅱ期24例,Ⅲ期9例,Ⅳ期3例,Ⅴ期2例。经后外侧入路行肿瘤切除36例,前后联合入路行肿瘤切除10例。39例采用颈椎后路钉棒内固定系统重建,3例采用前后联合固定,4例未行内固定。结果 1例术中发生椎动脉损伤,压迫止血。术后发生脑脊液漏19例,2例继发颅内感染,经相关处理后痊愈。术后随访6～125个月,2例恶性神经鞘瘤患者于术后8个月、14个月出现局部复发,再次行手术治疗,分别于术后21个月、38个月因肺部转移导致全身衰竭死亡。其余患者未见复发,随访仍在持续进行中。结论上颈段哑铃形肿瘤的外科治疗具有相当的难度与风险,外科分期系统有助于合理制定手术方案。经后外侧入路或联合前方入路可实现肿瘤切除与重建,应注意相关并发症的处理与预防,以提高疗效。
Objective To investigate the surgical treatment strategy and prognosis of dumbbell tumors in the upper cervical region. Methods From January 2000 to December 2009, 46 patients with dumbbell tumors of the upper cervical segment were retrospectively analyzed. The clinical features, surgical stages, surgical approaches, resection methods, internal fixation and reconstruction were analyzed. Tumor features include schwanoma in 33 cases, neurofibromas in 9 cases and malignant schwannoma in 4 cases. According to the surgical staging method of dumbbell-shaped tumors of cervical canal, 8 cases were stage Ⅰ, 24 cases were stage Ⅱ, 9 cases were stage Ⅲ, 3 cases were stage Ⅳ and 2 cases were stage Ⅴ. Thirty-six cases underwent resection of the posterior lateral approach and 10 cases underwent resection of the anterior or posterior approach. Thirty-nine cases were reconstructed by posterior cervical spine rod internal fixation system. Three cases were treated with anterior and posterior fixation and four cases without internal fixation. Results 1 case of intraoperative vertebral artery injury, compression hemostasis. Postoperative cerebrospinal fluid leakage in 19 cases, 2 cases of secondary intracranial infection, recovered after the relevant treatment. The patients were followed up for 6 to 125 months. Two patients with malignant schwannoma developed local recurrence at 8 months and 14 months after operation. Surgical treatment was performed again at 21 and 38 months after operation, respectively. Cause systemic failure death. No recurrence of the remaining patients, follow-up is still ongoing. Conclusion Surgical treatment of dumbbell tumors in the upper cervical region is quite difficult and risky. Surgical staging system is helpful to make reasonable surgical plans. The posterior lateral approach or joint anterior approach can achieve tumor resection and reconstruction, should pay attention to the treatment and prevention of complications, in order to improve the curative effect.