论文部分内容阅读
目的回顾性分析我院经外科治疗的脊柱骨巨细胞瘤(GCT)患者的临床信息,找出其中与肿瘤复发相关的关键因素。方法回顾性分析1995年1月至2009年3月我院收治的具有完整临床病理及随访资料的156例脊柱GCT病例。单因素分析患者的年龄、性别、肿瘤节段、Campanacci影像学分级、Jaffe病理学分级、既往有无复发史、手术方式(囊内刮除、扩大刮除、全脊椎整块切除和分块切除)等7项临床指标与肿瘤复发的关系。影响复发的多变量相关分析采用逻辑回归方法。结果 156例患者中外院手术复发后来我院就诊25例,首次来我院就诊131例;男71例,女85例,年龄16～68岁,首次发病平均年龄为31岁;肿瘤部位在颈椎34例(21.8%),胸椎52例(33.4%),腰椎31例(19.8%),骶尾椎39例(25.0%),累及2个以上椎节者11例。采取病灶囊内刮除39例,扩大刮除64例,全脊椎切除53例。随访时间18～165个月,平均59个月,绝大多数患者术后近期疗效满意。术后复发45例,其中再手术34例,3次手术3例,4次手术2例;31例患者首次复发在术后2年之内。病灶囊内刮除、广泛刮除、全脊椎切除术后肿瘤复发率分别为46.15%、26.56%、18.87%。单因素分析显示手术方式与脊柱GCT复发具有相关性,多因素逻辑回归分析显示手术方式是影响脊柱GCT复发的重要因素。结论手术方式是影响脊柱GCT复发的重要因素。全脊椎切除能显著降低局部复发率。手术后2年内密切随访十分重要。
Objective To retrospectively analyze the clinical information of surgically treated patients with giant cell tumor of the spine (GCT) in our hospital and find out the key factors related to tumor recurrence. Methods A retrospective analysis of 156 patients with GCT from January 1995 to March 2009 in our hospital with complete clinical pathology and follow-up data was performed. Univariate analysis of patients age, gender, tumor segment, Campanacci imaging grade, Jaffe pathological grade, with or without previous history of recurrence, surgical methods (intracapsular curettage, extended curettage, total spondylolitlectomy and partial resection ) And other 7 clinical indicators and tumor recurrence relationship. Multivariate correlation analysis that affected recurrence used logistic regression. Results Of the 156 cases, 25 cases were treated in our hospital after the recurrence of surgery. 131 cases were treated in our hospital for the first time. There were 71 males and 85 females, aged from 16 to 68 years old, with an average age of onset of 31 years. (21.8%), thoracic 52 (33.4%), lumbar 31 (19.8%), sacrococcygeal 39 (25.0%), involving more than two vertebral 11 cases. Thirty-nine patients underwent intracapsular curettage, 64 underwent extended curettage, and 53 underwent total spondylectomy. Follow-up time 18 to 165 months, an average of 59 months, the vast majority of patients with satisfactory short-term efficacy. Recurrence occurred in 45 cases, of which 34 cases were reoperation, 3 cases 3 cases and 4 cases 2 cases. The first recurrence in 31 cases was within 2 years after operation. The curettage of the lesions in the cysts and extensive curettage resulted in recurrence rates of 46.15%, 26.56% and 18.87% respectively after total spondylectomy. Univariate analysis showed that there was a correlation between surgical approach and GCT recurrence, and multivariate logistic regression analysis showed that surgical modality was an important factor affecting GCT recurrence. Conclusion The operative method is an important factor affecting the recurrence of GCT in the spine. Total splenectomy can significantly reduce the local recurrence rate. Close follow-up within 2 years after surgery is very important.