全脊椎整块切除术 ―― 一种治疗原发性恶性脊柱肿瘤新手术方法.docVIP

全脊椎整块切除术 ―― 一种治疗原发性恶性脊柱肿瘤新手术方法 　 作者：富田胜郎，马原，田慧中 【关键词】 肿瘤的可治愈性 摘 要：［目的］介绍一种整体切除脊柱原发性恶性肿瘤并使肿瘤治愈成为可能的新手术技术“全脊椎整块切除术”。背景资料：传统切除脊柱原发性恶性肿瘤的方法，是从肿瘤病灶内分块进行逐步切除。而经组织病理学证实，手术切缘较宽或较窄的病灶外整块切除的报告却鲜为有之。［方法］全脊椎整块切除术是在前路椎间支撑器植入，后路脊柱器械固定的情况下进行整块椎板切除和整块椎体切除的新手术技术。有5例患有原发性恶性肿瘤的患者及2例患有巨细胞瘤的患者施行了这种手术。除1例患者在术后7个月时因肿瘤转移到纵隔而死亡外，其余所有患者的观察期为2~65 a。［结果］除1例病人之外的所有患者在手术之后均获得了满意的临床效果，并且没有严重的并发症发生。经组织学研究证实，除椎弓根外，均获得了较宽或较窄的手术边缘，但在病变影响到椎管和脊柱的后方时，则需采用病灶内切除的传统方式。1例死于肿瘤转移的患者，其死亡原因与手术没有直接的相关性，且肿瘤切除的部位也没有局部复发的迹象。［结论］全脊椎整块切除术的优势在于，它是将整个椎体分两次予以完全切除，也就是一次切除椎体的一半，这种技术远胜于分块逐步切除的模式，并且是一次性完成整个手术的全过程。“全脊椎整块切除术”为脊柱原发性恶性肿瘤的治疗提供了一个更具有挑战性的手术方法。 关键词：恶性； 肿瘤的可治愈性； 原发性脊椎肿瘤； 手术分类； 手术切缘； 全脊椎整块切除术 Abstract：［Objective］To report a new surgical technique of total en bloc spondylectomy for complete resection of primary spinal malignancy and for oncologic curabilityThe conventional approach for primary spinal malignancy is via intralesional piecemeal resection,and very few reports have described en bloc extralesional resectioning with histopathologically wide or marginal surgical margins［Method］Total en bloc spondylectomy,consisting of en bloc laminectomy and en bloc corpectomy followed by anterior instrumentation with spacer grafting and posterior spinal instrumentation,was performed in five patients with primary malignant tumors and two patients with giant cell tumorsPatients were observed for 2 years to 65 years,except for one patient who died 7 months after surgery because of mediastinal metastasis［Result］All patients attained significant clinical improvement after surgery with no major complications except oneHistologically,the margins were wide or marginal except for the pedicles,and occasionally the spinal canal and the posterior,where they were accepted to be intralesionalOne patient died of metastasis that was not directly related to surgery itselfThere was no local recurrence［Conclusion］The advantages of total en bloc spondylectomy include resection of the involved vertebra（e）in two major blocs,rather than in a pi