| 胸腔镜辅助下Ⅰ期全脊柱整块切除在胸椎肿瘤中的临床应用 |
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投稿时间：2017-02-17
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| 作者 | Author | 单位 | Address | E-Mail |
| 薛文 |
XUE Wen |
甘肃省人民医院骨科, 甘肃 兰州 730000 |
Department of Orthopaedics, Gansu Province People's Hospital, Lanzhou 730000, Gansu, China |
xuewendoctor@sina.com |
| 管晓鹂 |
GUAN Xiao-li |
兰州大学第二医院骨科, 甘肃 兰州 730046 |
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| 王增平 |
WANG Zeng-ping |
甘肃中医药大学, 甘肃 兰州 730000 |
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| 郝忠玉 |
HAO Zhong-yu |
甘肃中医药大学, 甘肃 兰州 730000 |
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| 刘林 |
LIU Lin |
甘肃省人民医院骨科, 甘肃 兰州 730000 |
Department of Orthopaedics, Gansu Province People's Hospital, Lanzhou 730000, Gansu, China |
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| 钱耀文 |
QIAN Yao-wen |
甘肃省人民医院骨科, 甘肃 兰州 730000 |
Department of Orthopaedics, Gansu Province People's Hospital, Lanzhou 730000, Gansu, China |
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| 期刊信息：《中国骨伤》2017年，第30卷，第9期，第857-860页 |
| DOI：10.3969/j.issn.1003-0034.2017.09.015 |
| 基金项目:甘肃省卫生行业科研计划管理项目（编号：GWGL2014-10，1204FKCA113） |
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中文摘要:
目的：探讨借助前路胸腔镜辅助（thoracoscopically assisted surgery，TAS）后路Ⅰ期全脊柱整块切除（total en bloc spondylectomy，TES）治疗胸椎肿瘤的可行性及其疗效。
方法：2014年10月至2016年1月，采用前路TAS后路Ⅰ期TES治疗胸椎肿瘤4例，其中男2例，女2例，年龄分别为16、35、46、60岁；病程分别为1、4、6、9个月；病变累及T4、T6、T10各1例，T7/T8双节段1例；疼痛VAS评分分别为4、5、6、8分。Frankel脊髓损伤分级：B级2例，D级1例，E级1例。SF-36生存质量评分分别为38、65、35、29分；原发性脊柱肿瘤2例，转移性脊柱肿瘤2例。Tomita分型：Ⅲ型1例，Ⅳ型2例，Ⅵ型1例。WBB分期：4～9/ABCD 2例，5～8/ABC伴1～3 1例，6～7/ABC 1例。全身麻醉下，先取侧卧位，置入胸腔镜工作通道，结扎病椎椎间及相对应肋间血管，完成病椎椎前大血管游离保护，切开病椎上下椎间盘前1/2；改俯卧位，Ⅰ期后路行病椎整块切除及钛笼内植骨（同种异体骨）重建椎弓根螺钉内固定术。
结果：4例均获得随访，时间分别为34、10、11、12个月。其中术后发生胸腔积液1例，再次行胸腔闭式引流。手术切口均Ⅰ期甲级愈合。术后疼痛改善或消失，2个月时疼痛VAS评分2例2分，2例3分；术后无神经功能损害加重；术后SF-36生存质量评分改善明显，术后3个月评分分别为88、92、71、80分。术后3、6、12个月复查未见脊柱肿瘤复发、内固定松动及断裂；1例肺癌转移患者术后11个月因多器官功能衰竭死亡。
结论：前路TAS顺利完成了病椎椎体游离、椎前大血管、椎间血管、肋间血管分离保护或结扎，有效控制了术中出血，并且对肺、食管进行了有效保护，肿瘤获得了广泛性切除；前路TAS后路Ⅰ期TES显着降低手术创伤和手术风险，使TES向微创化迈进了一步，提高了手术安全性和疗效。 |
| 【关键词】胸椎 肿瘤 胸腔镜 全脊椎切除 |
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| Clinical application of anterior thoracoscopically assisted surgery with posterior one-stage total en block spondylectomy for thoracic spinal tumor |
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ABSTRACT
Objective: To investigate the clincial effects and feasibility of anterior thoracoscopically assisted surgery (TAS) with posterior one-stage total en block spondylectomy(TES) for thoracic spinal tumour.
Methods: From October 2014 to January 2016,4 patients with thoracic spinal tumour were treated by anterior thoracoscopically assisted surgery with posterior one-stage total en block spondylectomy. There were 2 males and 2 females,aged 16,35,46,60 years. Courses of disease were 1,4,6,9 months. The tumor occurred at T4,T6,T10 segment in 1 case respectively,at double T7/T8 segments in 1 case. Preoperative visual analogue scores(VAS) were 4,5,6,8 points. Frankel grade of neurologic function was grade B in 2,D in 1,and E in 1. SF-36 quality of life scores were 38,65,35,29 points,including 2 cases of primary spinal tumors,2 cases of metastatic spinal tumors. According to the classification of Tomita,1 case was type Ⅲ,2 cases were type Ⅳ,1 case was type Ⅵ.And according to the WBB staging,4-9/ABCD was in 2 cases,5-8/ABC compliated with 1-3 was in 1 case,6-7/ABC was in 1 case. Surgical procedure:With lateral position,the thoracoscope channel was inserted. The involved intervertebral vessels and corresponding intercostal vessels were ligated,while the prevertebral large vessels were completely separated and protected. The front halves of superior and inferior involved vertebral discs were removed. Then the patients were changed to prone position,posterior one-stage total en block spondylectomy,titanium cage bone graft (allograft bone),pedicle screw fixation were performed.
Results: All of the operations were successful and the patients were followed up for 34,10,11,12 months. Pleural effusion occurred in 1 case after operation,and pleural closed drainage was done. All incisions got primary healing;and all patients showed significant pain relief (P<0.005),with the VAS score decreasing to 2(2 cases) and 3(2 cases) scores,2 months after surgery. No nerve functional injury aggravated. SF-36 quality of life score obviously improved with postoperative scores for 88,92,71,80 at 3 months after operation. No recurrent vertebral tumor,internal fixation lossening or breakage was found at follow-up points of 3,6,12 months. One patient with lung cancer died of multiple organ failure at 11 months after operation.
Conclusion: With anterior TAS,vertebral anterior vessels,intervertebral blood vessels,intercostal vessels were successfully separated or ligated,intraoperative bleeding was effectively controlled,lung and esophagus were effectively protected,and the tumor received wide excision. Anterior TAS and one-stage posterior TES could significantly reduce the surgical trauma and the risk of surgery. |
| KEY WORDS Thoracic spine Neoplasms Thoracoscope Total spondylectomy |
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| 中文格式: | 薛文,管晓鹂,王增平,郝忠玉,刘林,钱耀文.胸腔镜辅助下Ⅰ期全脊柱整块切除在胸椎肿瘤中的临床应用[J].中国骨伤,2017,30(9):857~860 |
| 英文格式: | XUE Wen,GUAN Xiao-li,WANG Zeng-ping,HAO Zhong-yu,LIU Lin,QIAN Yao-wen.Clinical application of anterior thoracoscopically assisted surgery with posterior one-stage total en block spondylectomy for thoracic spinal tumor[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(9):857~860 |
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