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目的:探讨胸腔镜联合半椎板切除治疗胸椎管哑铃型肿瘤的临床疗效。方法:2007年6月至2009年1月收治6例胸椎管哑铃型肿瘤患者,男4例,女2例。年龄25～63岁,平均35.5岁,均采用胸腔镜联合后正中入路半椎板开窗切除病变。术后随访观察临床疗效并行MRI检查,观察肿瘤切除情况及对脊柱稳定性的影响。结果:6例患者均手术全切肿瘤,无1例死亡。手术时间3～5h,平均3.8h;术中失血量80～300ml,平均130ml。伤口均一期愈合,无脑脊液漏及切口、胸腔感染发生。病理检查结果示神经鞘瘤5例,脊膜瘤1例。术后患者症状均有不同程度缓解,5例有胸背疼痛患者疼痛消失,3例术前有脊髓压迫症状者,其中2例完全恢复,1例双下肢瘫痪者术后肌力恢复至4+级。复查MRI均未见肿瘤残留。随访6个月～2年,所有患者均未见肿瘤复发及脊柱不稳定。结论:应用胸腔镜联合半椎板开窗切除胸椎管哑铃型肿瘤有较好的临床疗效。
Objective: To investigate the clinical effect of thoracoscope combined with semi-laminectomy in the treatment of dumbbell tumor of thoracic spinal canal. Methods: From June 2007 to January 2009, 6 patients with dumbbell tumor of thoracic spinal canal were treated, including 4 males and 2 females. Aged 25 to 63 years old, average 35.5 years old, were treated with thoracoscopy combined with midline approach to remove the lesion. Postoperative follow-up observation of clinical efficacy and MRI examination to observe the tumor resection and the stability of the spine. Results: All the 6 patients were surgically resected and none of them died. Surgery time 3 ~ 5h, an average of 3.8h; intraoperative blood loss 80 ~ 300ml, an average of 130ml. Wounds were healed, no cerebrospinal fluid leakage and incision, chest infection occurred. Pathological examination showed nerve sheath tumors in 5 cases, 1 case of meningiomas. Postoperative symptoms were relieved to varying degrees, 5 cases of pain in patients with chest and back pain disappeared, 3 cases of preoperative symptoms of spinal cord compression, of which 2 cases fully recovered, 1 case of lower limb paralysis after muscle strength restored to 4+ level. Review of MRI were no tumor residue. All the patients were followed up for 6 months to 2 years. No tumor recurrence and spine instability were observed in all patients. Conclusion: Thoracoscopic thoracoscopic combined with semi-laminar fenestration in the removal of thoracic dumbbell tumor has a good clinical effect.