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目的探讨Ⅰ期后路经肋横突切除入路摘除胸椎哑铃型肿瘤的解剖学可行性和安全性。方法回顾2006.8-2011.10间收治的20例胸椎哑铃状肿瘤的临床资料,均采用单一后路Ⅰ期手术切除肿瘤。JOA评价神经功能,X线评估内固定和融合结果,MRI检查肿瘤切除彻底性和是否复发。结果肿瘤均完全切除,平均手术时间263min(152~420 min),出血量480 ml(125~1770 ml)。Schwann细胞瘤9例,神经纤维瘤6例,脊膜瘤3例,神经节细胞瘤2;其中硬膜外12例、髓外硬膜下8例。随访末期神经功能显著改善,JOA恢复率72.9%;VAS评分由术前8.3±0.67改善为随访末期2.3±0.19;并发症包括胸膜破裂2例,肺不张和胸腔内脑脊液漏各1例。结论单一后方肋横突、椎板切除入路可以完整切除胸椎哑铃型肿瘤,适用于肿瘤与大血管、胸腔脏器粘连较轻者。
Objective To investigate the anatomical feasibility and safety of transsphenoidal approach to remove dumbbell tumors in the thoracic cavity. Methods The clinical data of 20 cases of dumbbell tumor of thoracic cavity treated between 2006.8-2011.10 were retrospectively reviewed. JOA evaluated neurological function, X-ray assessment of internal fixation and fusion results, MRI examination of complete tumor resection and recurrence. Results The tumors were completely resected. The average operation time was 263 minutes (152-420 minutes) and the bleeding volume was 480 ml (125-1770 ml). Schwann cell tumor in 9 cases, neurofibroma in 6 cases, 3 cases of meningiomas, ganglioneuroma 2; of which 12 cases of extradural extramedullary subdural in 8 cases. The neurological function improved significantly at the end of follow-up, and the recovery rate of JOA was 72.9%. The VAS score improved from 8.3 ± 0.67 before surgery to 2.3 ± 0.19 at the end of follow-up. Complications included pleural rupture in 2 cases, atelectasis and intrathoracic cerebrospinal fluid leakage in 1 case. Conclusions A single posterior transverse process of the transverse ribs and laminectomy can completely remove the dumbbell tumor of the thoracic cavity, which is suitable for the lesser adhesion of the tumor to the large blood vessels and the thoracic cavity.