前方入路手术治疗上胸椎转移瘤

Surgical treatment of upper thoracic spine metastatic tumor via anterior approach

中文关键词:  转移瘤  上胸椎  前路  内固定

英文关键词:Metastatic tumor  Anterior  Upper thoracic vertebrae  Internal fixation

中文摘要:

  【摘要】 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±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±16.5（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。

英文摘要:

  【Abstract】 Objectives: To discuss the techniques and outcomes of anterior approach for metastasis resection and reconstruction with titanium plate for upper thoracic vertebral tumor. Methods: From June 2004 to July 2011, there were 6 males and 11 females with the average age of 55.1±7.3 years(range, 47-68 years) with the upper thoracic(T1-T4) metastatic tumor underwent anterior resection and fixation. Their neurological function was assessed by Frankel classification as following, 3 cases with grade B, 4 cases with grade C, 8 cases with grade D and 2 cases with grade E. The tumors located at T1 in 7 cases, T2 in 5 cases, T3 in 3 cases, T4 in 2 cases. Tokuhashi scoring system of 17 cases ranged from 9 to 12 points. The tumors located in the vertebral body of sectors 4-9 based on the WBB staging system. For T1 lesion, low anterior cervical approach was used, and for T2-T4 lesion, anterior transsternal approach of outside window of brachiocephalic artery was used. Results: All patients survived the surgery, the operation time of anterior cervical approach was 90-102min(average: 94.1±5.0min), blood loss was 100-400ml(average: 186.6±100.2ml); the operation time of anterior transsternal approach outside window of brachiocephalic artery was 100-150min(average: 121.0±16.5min), blood loss was 220-600ml(average: 352.0±134.4ml). Pathological examination revealed metastatic lung cancer in 6 patients, metastatic breast cancer in 5 patients, metastatic thyroid carcinoma in 2 patients， metastatic gastrointestinal cancer in 2 patients and uncertainly metastatic tumor in 2 patients. Pneumonia and atelectasis occurred in 2 patients and recovered well after proper treatment; 3 patients appeared transient hoarseness and returned to normal 1 month later. The mean follow-up was 19.7±9.8 months(range, 6 to 48 months). Neurological function improved in 9 cases, 2 patients improved from grade B to E, 1 patient improved from grade B to grade D; 2 patients in grade C improved to grade E, 2 patients in grade C improved to grade D and 2 patients in grade D improved to grade E. 5 patients died of systemic failure due to multiple metastases at 6-14 months. Conclusions: The anterior approach is reliable for thoracic spinal metastasis, which is superior for sufficient exposure and removal of vertebral defects．