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目的:探讨前方入路行上胸椎肿瘤切除、椎体重建、钛板内固定的技术及方法,分析手术治疗效果及相关并发症。方法:2004年6月~2011年7月我科收治上胸椎(T1~T4)转移瘤患者17例,其中男6例,女11例,年龄55,1±7.3岁(47~68岁)。术前神经功能按Frankel分级:B级3例,C级4例,D级8例,E级2例。肿瘤位置:T1 7例,T2 5例,T3 3例,T4 2例。按Tokuhashi脊柱转移瘤评分系统评分为9~12分;根据WBB分区理论肿瘤病灶位于4~9区。对于T1椎体病灶患者采用低位下颈椎前方入路;对于T2~T4椎体病灶患者采用前方劈开胸骨经头臂干外侧间隙入路。结果:所有患者均能很好耐受手术,低位下颈椎前方入路手术时间为94.1士5.0min(90~102min),出血量为186.6±100.2ml(100~400ml);前方劈开胸骨经头臂干外侧间隙入路手术时间为121.0±165(100~150min),出血量为352.0±134.4ml(220~600ml)。术后病理学检查:6例来源于肺癌,5例来源于乳腺癌,2例来源于甲状腺癌,2例来源于胃肠道癌,2例来源不明。术后2例前方劈开胸骨经头臂干外侧间隙入路手术患者出现肺部感染、肺不张,经对症治疗后治愈。3例(其中1例为低位下颈椎前方入路手术患者)出现喉返神经牵拉伤致一过性声音嘶哑,术后1个月内声音恢复正常。随访19.7±9.8个月(6~48个月),9例患者神经功能有不同程度改善,其中3例Frankel分级B级患者2例改善为E级,1例改善为D级;4例C级2例改善到E级,2例改善到D级;2例D级患者改善到E级。5例患者在术后6~14个月因多处转移、全身衰竭死亡。结论:前方入路是治疗上胸椎转移瘤可供选择的有效入路,该入路可以充分显露前方椎体病变,有效切除病灶,彻底解除来自脊髓前方的压迫,改善患者症状。
Objective: To explore the technique and method of resection of thoracic tumor, reconstruction of vertebral body and internal fixation of titanium plate in anterior approach. To analyze the effect of surgical treatment and related complications. Methods: From June 2004 to July 2011, 17 patients with metastatic tumors of the thoracic vertebra (T1 ~ T4) were treated in our department. There were 6 males and 11 females, aged 55.1 ± 7.3 years (47-68 years). Preoperative neurological function according to Frankel classification: B grade in 3 cases, C grade in 4 cases, D grade in 8 cases, E grade in 2 cases. Tumor location: T1 7 cases, T2 5 cases, T3 3 cases, T4 2 cases. According to Tokuhashi spine metastasis scoring system score of 9 to 12 points; according to WBB zoning theoretical tumor lesions in 4 to 9 areas. For patients with T1 vertebral lesions using low anterior cervical approach; for T2 ~ T4 vertebral lesions in patients with anterior cleft sutures through the lateral sural trunk clearance approach. Results: All patients were well tolerated surgery, low anterior cervical approach time was 94.1 ± 5.0min (90 ~ 102min), the amount of bleeding was 186.6 ± 100.2ml (100 ~ 400ml); anterior cleft sternum head The operation time of lateral arm approach was 121.0 ± 165 (100-150 minutes) and the amount of bleeding was 352.0 ± 134.4ml (220-600ml). Postoperative pathological examination included 6 cases of lung cancer, 5 cases of breast cancer, 2 cases of thyroid cancer, 2 cases of gastrointestinal cancer, and 2 cases of unknown origin. 2 cases of postoperative cleft sternum in front of the lateral sural trunk clearance surgery patients with pulmonary infection, atelectasis, cured after symptomatic treatment. Three cases (including one in the lower anterior cervical spine surgery) had a recurrent laryngeal nerve injury caused by a hoarse voice, within 1 month after the sound returned to normal. The follow-up was 19.7 ± 9.8 months (range, 6 ~ 48 months). The neurological function of 9 patients improved to some degree. Among them, 3 cases of Frankel grade B improved to grade E and 2 to grade D; 2 cases improved to E level, 2 cases improved to D level; 2 cases D class improved to E level. Five patients died of systemic failure after multiple metastases 6 to 14 months after surgery. Conclusion: The anterior approach is an effective approach for the treatment of upper thoracic metastases. This approach can fully reveal the anterior vertebral lesions, effectively remove the lesions, completely relieve the oppression from the front of the spinal cord, and improve the symptoms of patients.