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目的探讨原发性恶性腰椎肿瘤全脊椎切除手术入路、肿瘤切除术式、重建策略及预后。方法回顾性分析1998年1月至2004年12月收治的30例原发性恶性腰椎肿瘤患者的病理类型、临床表现、手术途径、术式及其预后。本组30例中,肿瘤病灶涉及WBB分区3～9区/1～12区和L1～L5椎节。采用后方入路14例,前后联合入路16例。1个椎节切除28例,2个椎节切除1例,3椎节切除1例。根据手术入路的不同而行后路或前后路行全椎节切除与重建术。根据肿瘤的病理类型,术后给予相应的全身/局部化疗或放疗。结果术后随访1～6年,1例神经症状无改善,其余术后近期疗效均较满意,神经功能均有不同程度改善。6例患者分别于术后12～48个月局部复发,1例恶性纤维组织细胞瘤患者于术后36个月因多处转移、全身衰竭死亡。结论肿瘤的性质、切除方式和术后的相关综合治疗对预后具有重要影响,应根据肿瘤的性质、浸润范围选择相应的手术途径及肿瘤切除与重建方式。
Objective To investigate the surgical approach of total spondylectomy for primary malignant lumbar tumors, tumor resection, reconstruction strategy and prognosis. Methods The pathological types, clinical manifestations, surgical approaches, surgical procedures and prognosis of 30 patients with primary malignant lumbar tumors admitted from January 1998 to December 2004 were retrospectively analyzed. The group of 30 cases, the tumor lesions involving WBB District 3 to 9/1 to 12 and L1 ~ L5 vertebral. The posterior approach was used in 14 cases and the anterior and posterior approach was used in 16 cases. One vertebral resection in 28 cases, two vertebral resection in 1 case, 3 vertebral resection in 1 case. According to the different surgical approach after the road or before and after the line of total vertebral resection and reconstruction. According to the pathological type of the tumor, corresponding systemic / local chemotherapy or radiotherapy is given after the operation. Results The patients were followed up for 1 to 6 years. No neurological symptoms were found in one case. The remaining short-term results were satisfactory and the neurological function improved in varying degrees. Six patients were locally recurred 12 to 48 months after surgery. One case of malignant fibrous histiocytoma died of systemic failure due to multiple metastases at 36 months after operation. Conclusions The nature of the tumor, the mode of resection and the postoperative related comprehensive treatment have an important influence on the prognosis. According to the nature of the tumor and the extent of infiltration, the corresponding surgical approaches and tumor resection and reconstruction methods should be selected.