一期后路全脊椎切除术治疗多椎节脊柱肿瘤

Clinical outcomes of one-stage total en bloc spondylectomy in multi-level spinal tumor

中文关键词:  脊柱肿瘤  多节段  全脊椎切除术  临床结果  生存期

英文关键词:Spine tumor  Multi-level  Total en bloc spondylectomy  Clinical outcome  Survival time

中文摘要:

  【摘要】 目的：探讨一期后路全脊椎切除术治疗多椎节脊柱肿瘤的安全性和有效性。方法：回顾性分析2009年11月~2015年9月因多椎节脊柱肿瘤于我院行全脊椎切除术（total en bloc spondylectomy，TES）且资料完整的9例患者，男8例，女1例；年龄42.0±13.7岁（24~64岁）。原发肿瘤5例，其中骨巨细胞瘤2例，恶性神经鞘膜瘤、造釉细胞瘤、间叶源性肿瘤各1例；转移性肿瘤4例，其中肾癌、肝癌、前列腺癌、脂肪肉瘤各1例。记录手术时间、术中出血量、输血量、并发症、住院天数、术前及术后疼痛程度、神经功能情况。术后随访观察肿瘤是否复发、远处转移以及患者存活情况。结果：9例患者均成功接受一期后路多椎节全脊椎切除术，其中2椎节切除6例，3椎节2例，4椎节1例。手术时间8.9±2.8h（7~16h）、术中出血量3422.2±1342.4ml（1700～6000ml）、输血量2200.0±842.6ml（1000~4000ml）、住院时间31.1±20.3d（14~73d）。3例患者术中硬膜撕裂，1例胸膜破裂，3例患者术后出现胸腔积液，1例4椎体切除患者术后出现胸腔感染，无神经、大血管损伤等严重并发症。围手术期无死亡病例。1例患者随访期间出现钛网下沉，其他无内固定并发症。术后VAS评分（0.9±1.1分）较术前（7.1±1.2分）明显下降（P<0.05）。术前脊髓神经功能5例ASIA分级为E级，术后仍为E级；3例术前D级，2例恢复至E级，1例仍为D级；1例术前C级，术后恢复至D级。9例患者均得到随访，随访时间29.8±15.2个月（12~61个月），随访期内6例患者局部无肿瘤复发，另3例患者分别于术后8个月、18个月、28个月时发现手术部位局部肿瘤复发。4例死亡，其中3例因全身多发转移死亡，1例死于肿瘤复发引起的并发症，中位生存期为34.75个月。结论：一期后路全脊椎切除术治疗多椎节脊柱肿瘤仍是高风险、高难度手术，但是可以术后即刻改善患者生活质量，需严格把握手术指征。

英文摘要:

  【Abstract】 Objectives: A retrospective study was designed to evaluate the clinical outcomes of one-stage total en bloc spondylectomy for multi-level spinal tumor. Methods: From November 2009 to September 2015, 9 patients who suffered from multi-level spinal tumor and accepted total en bloc spondylectomy(TES) were included in this study. There were 8 men and 1 woman with a mean age of 42.0±13.7 years old(24-64 years). 5 cases were with the primary tumor including 2 giant cell tumors, 1 malignant nerve sheath tumor, 1 ameloblastoma and 1 mesenchymal tumor. The other 4 cases were with metastatic tumors including 1 renal carcinoma, 1 hepatocarcinoma, 1 prostate cancer and 1 liposarcoma. The operation time, intraoperative blood loss, blood transfusion, complications, length of stay, preoperative and postoperative pain, and neurological function were recorded. Tumor recurrence, tumor metastasis and survival were observed during follow-up period. Results: The 9 patients were all successfully operated. 6 of them were with 2 levels of spinal tumor, 2 with 3 levels and 1 with 4 levels. The average operation time was 8.9±2.8h(7-16h), the average blood loss was 3422.2±1342.4ml(1700-6000ml), the average blood transfusion was 2200.0±842.6ml(1000-4000ml), and the average length of stay was 31.1±20.3d(14-73d). Postoperative VAS score decreased significantly when compared with preoperative score(P<0.05). There was no death during perioperative period. Three patients suffered from intraoperative dura rupture, 1 patient suffered from intraoperative pleura rupture, 3 patients suffered from postoperative hydrothorax, and 1 patient suffered from thoracic cavity infection. One patient suffered from titanium mesh subsidence. There was no other serious postoperative complication, such as neurological damage or vascular damage. Five patients were Frankel grade E before operation, and still grade E after operation. Three patients were grade D, 2 of them improved to grade E and 1 was still grade D after operation. One patient was grade C, and recovered to grade D after operation. The mean follow-up time was 29.8±15.2 months(12-61 months). There was no local recurrence in 6 patients. And 3 patients suffered from local recurrence on 8, 18 and 28 months after operation, respectively. Three patients died due to systemic metastasis, one died of complications results of local recurrence. The median survival time was 34.75 months. Conclusions: One-stage total en bloc spondylectomy is a still high risk and challenge but effective operation for multi-level spinal tumor. The indication for this procedure needs to be weighed.