上颈椎原发肿瘤的治疗———附21例报告

Treatment of primary upper cervical tumors：21 cases report

中文关键词:  上颈椎  脊柱肿瘤  手术治疗

英文关键词:Upper cervical spine  Spinal neoplasm  Surgical treatment

中文摘要:

  【摘要】 目的：探讨上颈椎原发肿瘤的合理治疗方法。方法：2001年1月至2006年11月共收治上颈椎原发肿瘤患者21例，男12例，女9例，年龄12～64岁，平均37.2岁。其中脊索瘤12例，骨巨细胞瘤7例，软骨肉瘤1例，恶性神经鞘瘤1例。表现为颈部疼痛不适12例，活动受限11例，脊髓损害10例，咽部肿物伴疼痛1例。就诊时肿瘤已突破骨间室者19例，肿瘤累及前中后三柱者14例。3例因无法负担手术费用而仅行保守治疗，18例行手术治疗，1例肿瘤仅累及后柱及附件背侧软组织，选择后方正中入路手术；17例肿瘤累及三柱或侧柱和/或侧块周围软组织，选择前后方联合入路。均为经瘤切除。9例患者在手术期前后行放射治疗（放疗），1例骨巨细胞瘤使用干扰素免疫治疗。随访观察治疗效果。结果：3例行保守治疗患者确诊后平均3个月死亡。手术病例中，术中结扎一侧椎动脉4例，术后无明显症状。1例术后死于围手术期气道阻塞，另17例平稳度过围手术期，其中13例症状（疼痛或脊髓损害）较术前明显缓解；2例术后出现一过性的四肢瘫，术后3个月后渐恢复；另2例脊髓功能无改善。术后1例咽后壁伤口裂开，再次缝合；另1例咽后壁伤口不愈合、内固定外露，无感染，未处理。2例失访，15例随访4～82个月，平均37.2个月。4例无瘤存活；11例复发，其中8例死亡，3例带瘤存活。结论：上颈椎原发肿瘤确诊时往往浸润广泛，需根据肿瘤位置合理选择手术入路，切除不易彻底，术后易复发。

英文摘要:

  【Abstract】 Objective：To investigate the appropriate surgical strategy for primary upper cervical tumors. Method：From January 2001 to November 2006，a total of 21 cases（12 males and 9 females） with the average age at admission of 37.2 years old（range，12-64 years old） were reviewed retrospectively.The pathological diagnosis was chordoma in 12 cases，giant cell tumor in 7，chondrosarcoma in 1 and malignant schwannoma in 1.At diagnosis，12 cases had neck pain，11 had neck restriction，10 had neurological deficit and 1 had throat pain.19 had extra-compartment lesions and 14 had both the anterior and posterior element involved.The surgical approach was determined according to the tumor site.3 cases refused to operation and accepted radiotherapy due to financial cost，another 18 had surgery which included combined anterior and posterior approaches in 17 cases due to three columns or posterior soft tissue involved and posterior approach in 1 case due to posterior elements alone involved.All cases underwent complete tumor resection and 9 cases had adjuvant pre and post surgery radiotherapy，1 case with giant cell tumor underwent treatment of interferon.4 cases had unilateral vertebral arteries legated without any postoperative symptoms.Result：The average survivor for cases without operation was 3 months.While for cases accepting operation，1 died of respiratory failure postoperatively，the other 17 cases underwent surgery successfully.Preoperative symptoms relieved in 13 cases and remained no change in 2 cases.2 cases suffered transient quadriplegia which recovered 3 month later.2 cases had retropharyngeal wound dehiscence，one underwent debridement，while the other accepted no treatment due to no infection and no symptom despite of internal fixation exposure.15 cases had an average of 37.2 months follow-up and the other 2 cases were lost.At final follow-up，4 cases were alive with no tumor，8 cases died of local recurrence，3 cases were alive with local recurrence.Conclusion：Primary upper cervical malignant tumors often infiltrate extensively at diagnosis. Surgical approach should be determined based on tumor site to avoid high recurrence.