胸腰椎骨巨细胞瘤手术治疗后复发的原因分析

Risk factors of recurrence after surgery for thoracolumbar giant cell tumor

中文关键词:  脊柱  骨巨细胞瘤  手术切除  复发

英文关键词:Spine  Giant cell tumor  Surgical treatments  Recurrence rate

中文摘要:

  【摘要】 目的：探讨胸腰椎骨巨细胞瘤（giant cell tumor，GCT）手术治疗后复发的原因。方法：2005年1月~2010年9月我院手术治疗胸腰椎GCT共20例，男10例，女10例；年龄11~49岁，平均34.0岁，＜30岁者7例，30~60岁者13例。病变位于胸椎13例，腰椎7例；病灶仅累及单节段脊椎15例，双节段1例，3个节段4例；均为Enneking S3期。15例为首次手术治疗，5例因复发而再次手术。行刮除术9例，经瘤包膜外彻底切除术7例，全脊椎整块切除术（TES）4例。手术时间168~690min，平均440.5min；术中出血量为1050~8500ml，平均3286ml。术后放疗7例。采用卡方Fisher精确检验，分析术后GCT复发率与患者性别、年龄、病变节段、首次手术与否、手术方式、手术时间、术中出血量、术后放疗与否的相关性。结果：3例失访，17例随访18~86个月，平均48.0个月。11例患者未见复发，6例患者局部复发。病灶累及胸椎者的术后复发率为3/11，腰椎为3/6；男性患者术后复发率为2/9，女性为4/8；年龄＜30岁者术后复发率为1/6，30~60岁者为5/11；首次手术治疗的术后复发率为5/13，因复发再次手术的复发率为1/4；手术时间＜7h者复发率为4/6，≥7h者为2/11；术中出血量＜3000ml者术后复发率为2/7，≥3000ml者为4/10；采用刮除术者术后复发率为6/7，采用经瘤包膜外彻底切除术及整块切除术者无复发，采用刮除术的复发率明显高于另外两组；术后放疗者复发率为5/7，未行放疗者为1/10。局部复发组患者的性别、年龄、病变受累节段、手术次数、手术时间及术中出血量与未复发组比较无统计学差异（P＞0.05），手术方式及术后放疗与否复发组与未复发组比较有统计学差异（P＜0.05）。结论：胸腰椎GCT手术治疗后的复发与手术方式直接相关，整块切除或经瘤的包膜外彻底切除可明显降低复发率。

英文摘要:

  【Abstract】 Objectives: To investigate the risk factors of recurrence after surgery for thoracolumbar giant cell tumor(GCT). Methods: From January 2005 to September 2010, 20 cases of thoracic and lumbar GCT were operated in our department. There were 10 males and 10 females; the average age at presentation was 34.0 years(range, 11-49 years). 7 cases were younger than 30 years, and 13 cases were between 30-60 years. 13 cases had thoracic lesions and 7 had lumbar spine involved; 15 cases had primary surgery and 5 had revision surgery after GCT recurrence; 15 cases had one vertebra involved, 1 had 2 vertebrae involved and 4 had 3 vertebrae involved. Three types of surgery were used: (1)curettage in 9 cases, (2)intralesional extracapsular excision in 7 cases, (3)en-bloc excision(ES) in 4 cases. The average surgical time was 440.5min(range, 168-690min); the average estimated bleeding was 3268ml(range, 1050-8500ml). 7 cases underwent radiotherapy after surgery. All cases were at Enneking S3 stage. The correlation of incidence of GCT recurrence with gender, age, distribution in spine, primary treatment or not, surgical treatment, surgical time, intraoperative blood loss, postoperative radiation or not was reviewed respectively. The IBM SPSS statistics 19.0 software was used for statistical analysis, the chi-square Fisher′s exact test for the correlation between the above risk factors and incidence of recurrence was analyzed. Results: Among the 20 cases, 3 lost follow-up, and the other 17 cases were followed up for an average of 48 months(18-86 months), 6 cases were noted recurrence. The recurrence rate for thoracic was 3/11, and 3/6 for lumbar, which showed no significant difference(P＞0.05); while the recurrence rate of male was 2/9, and the female recurrence rate was 4/8, which showed no significant difference(P＞0.05); the recurrence rate of the patients below 30 years was 1/6, and that of those 30 to 60 years old was 5/11, which showed no significant difference(P＞0.05); the recurrence rate for the primary surgery cases was 5/13, and that for the revision cases was 1/4, which showed no significant difference(P＞0.05); the recurrence rate with less surgery time(less than 420min) was 4/6, and that with longer surgery time(more than 420min) was 2/11, which showed no significant difference(P＞0.05); the recurrence rate with less bleeding(less than 3000ml) was 2/7, and that with more bleeding(more than 3000ml) was 4/10, which showed no significant difference(P＞0.05); the recurrence rate for curettage was 6/7, and no recurrence was observed in cases with intralesional extracapsular excision and ES, which showed significant difference（P＜0.05）; the recurrence rate for radiotherapy was 5/7, and 1/10 for no radiotherapy, which showed significant difference(P＜0.05). Conclusions: The recurrence rate of thoracolumbar GCT is directly related to the types of surgery. ES and the intralesional extracapsular excision can decrease the recurrence rate significantly.