目的:探讨上颈椎原发肿瘤的合理治疗方法。方法:2001年1月至2006年11月共收治上颈椎原发肿瘤患者21例,男12例,女9例,年龄12～64岁,平均37.2岁。其中脊索瘤12例,骨巨细胞瘤7例,软骨肉瘤1例,恶性神经鞘瘤1例。表现为颈部疼痛不适12例,活动受限11例,脊髓损害10例,咽部肿物伴疼痛1例。就诊时肿瘤已突破骨间室者19例,肿瘤累及前中后三柱者14例。3例因无法负担手术费用而仅行保守治疗,18例行手术治疗,1例肿瘤仅累及后柱及附件背侧软组织,选择后方正中入路手术;17例肿瘤累及三柱或侧柱和/或侧块周围软组织,选择前后方联合入路。均为经瘤切除。9例患者在手术期前后行放射治疗(放疗),1例骨巨细胞瘤使用干扰素免疫治疗。随访观察治疗效果。结果:3例行保守治疗患者确诊后平均3个月死亡。手术病例中,术中结扎一侧椎动脉4例,术后无明显症状。1例术后死于围手术期气道阻塞,另17例平稳度过围手术期,其中13例症状(疼痛或脊髓损害)较术前明显缓解;2例术后出现一过性的四肢瘫,术后3个月后渐恢复;另2例脊髓功能无改善。术后1例咽后壁伤口裂开,再次缝合;另1例咽后壁伤口不愈合、内固定外露,无感染,未处理。2例失访,15例随访4～82个月,平均37.2个月。4例无瘤存活;11例复发,其中8例死亡,3例带瘤存活。结论:上颈椎原发肿瘤确诊时往往浸润广泛,需根据肿瘤位置合理选择手术入路,切除不易彻底,术后易复发。 Objective: To investigate the reasonable treatment of primary cervical spine tumors. Methods: From January 2001 to November 2006, 21 cases of primary cervical cancer were treated, including 12 males and 9 females, aged from 12 to 64 years (average 37.2 years). Including chordoma in 12 cases, giant cell tumor in 7 cases, 1 case of chondrosarcoma, 1 case of malignant schwannoma. 12 cases showed neck pain discomfort, 11 cases of limited mobility, spinal cord injury in 10 cases, pharyngeal mass with pain in 1 case. At the time of treatment, the tumor had broken through the interosseous chamber in 19 cases, and the tumor involved 14 cases in the former three columns. 3 cases were treated conservatively because they could not afford the operation cost, 18 cases were treated by surgery, 1 case had the posterior column and appendage dorsal soft tissue involvement, and the posterior median approach was selected. Seventeen cases of tumors involved three columns or columns and / Or soft tissue around the side block, select the front and rear side of the joint approach. All tumor removal. Nine patients underwent radiotherapy (radiotherapy) before and after surgery and one giant cell tumor of bone using interferon immunotherapy. Follow-up observation of the therapeutic effect. Results: 3 patients with conservative treatment died of an average of 3 months after diagnosis. Surgical cases, intraoperative ligation of the vertebral artery in 4 cases, no obvious symptoms. One patient died of perioperative airway obstruction, and the other 17 patients underwent perioperative stabilization. Thirteen patients (pain or spinal cord injury) were significantly relieved compared with those before operation. Two patients had transient quadriplegia , Recovered gradually after 3 months; the other 2 cases showed no improvement of spinal cord function. One case of post-retropharyngeal wound was split open and sutured again. Another case was non-union of wounds of posterior pharyngeal wall, exposed in internal fixation without infection or untreated. Two patients were lost to follow-up, and 15 patients were followed up for 4 to 82 months with an average of 37.2 months. Four patients survived without tumor; 11 patients relapsed, 8 patients died and 3 patients survived. Conclusion: The diagnosis of primary cervical tumors often infiltration is widespread, according to the tumor location of a reasonable choice of surgical approach, not easy to remove completely, easy to relapse after surgery.