切换至 "中华医学电子期刊资源库"
高级检索
中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2021, Vol. 11 ›› Issue (06) : 366 -369. doi: 10.3877/cma.j.issn.2095-123X.2021.06.010

短篇论著

经外侧腹膜后入路显微手术治疗腰椎椎旁肿瘤
陈世超1, 王凯2, 王作伟2, 吴浩2,†()   
  1. 1. 100015　北京，首都医科大学附属北京地坛医院神经外科
    2. 100530　北京，首都医科大学宣武医院神经脊柱中心
  • 收稿日期:2021-10-08 出版日期:2021-12-15
  • 通信作者: 吴浩

Microsurgical treatment of lumbar paravertebral tumors via lateral retroperitoneal approach

Shichao Chen1, Kai Wang2, Zuowei Wang2, Hao Wu2,†()   

  1. 1. Department of Neurosurgery, Beijing Ditan Hospital Affiliated to Capital Medical University, Beijing 100015, China
    2. Neurospinal Center, Xuanwu Hospital of Capital Medical University, Beijing 100530, China
  • Received:2021-10-08 Published:2021-12-15
  • Corresponding author: Hao Wu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

陈世超, 王凯, 王作伟, 吴浩. 经外侧腹膜后入路显微手术治疗腰椎椎旁肿瘤[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(06): 366-369.

Shichao Chen, Kai Wang, Zuowei Wang, Hao Wu. Microsurgical treatment of lumbar paravertebral tumors via lateral retroperitoneal approach[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(06): 366-369.

目的

探讨经外侧腹膜后入路显微手术治疗腰椎椎旁肿瘤的技术特点及治疗效果。

方法

回顾性分析首都医科大学宣武医院神经脊柱中心自2019年6月至2020年12月经外侧腹膜后入路手术治疗的6例腰椎椎旁肿瘤患者的临床资料，统计患者手术时间、出血量、切口长度、住院时间、占位切除率、日常生活能力（ADL）评分及术后并发症情况。

结果

本组患者手术时间范围56~181 min，出血量范围5~100 mL，手术切口长度范围6~7 cm，住院时间范围5~11 d。椎旁肿瘤切除率100%。术后病理诊断神经鞘瘤4例，节细胞神经瘤1例，小圆细胞恶性肿瘤1例。随访3个月，肿瘤无复发，无腹腔感染及切口感染，无切口疝，无死亡病例，ADL评分较术前无明显减低。

结论

经外侧腹膜后入路手术治疗腰椎椎旁肿瘤具有手术时间短、微创、恢复快、并发症少等特点，值得临床推广。

关键词: 外侧腹膜后入路, 腰椎椎旁占位, 显微手术
Objective

To investigate the technical characteristics and therapeutic effect of lateral retroperitoneal microsurgery in the treatment of lumbar paravertebral tumors.

Methods

The clinical data of 6 cases of lumbar paravertebral tumors surgery through lateral retroperitoneal approach in the Neurospinal Center of Xuanwu Hospital of Capital Medical University from June 2019 to December 2020 were retrospectively analyzed. The average operation time, blood loss, Incision length, resection rate, length of hospital stay, activities of daily living (ADL) score and postoperative complications were analyzed.

Results

The operation time ranged from 56 to 181 min, the amount of bleeding ranged from 5 to 100 mL, the length of surgical incision ranged from 6 to 7 cm, and the hospital stay ranged from 5 to 11 d. The resection rate of paravertebral tumor was 100%. Postoperative pathological diagnosis included schwannoma in 4 cases, ganglioneuroma in 1 case and small round cell malignant tumor in 1 case. After 3 months of follow-up, there was no recurrence, no abdominal infection, no incision infection, no incisional hernia, no death, and no significant decrease in ADL score.

Conclusion

The lateral retroperitoneal approach in the treatment of lumbar paravertebral tumors has the characteristics of short operation time, minimally invasive, rapid recovery and few complications, which is worthy of clinical promotion.

Key words: Lateral retroperitoneal approach, Lumbar paravertebral tumors, Microsurgery
表1 6例腰椎椎旁占位患者的临床资料
序号 性别 年龄（岁） 侧别 节段 手术时间（min） 住院时间（d） ADL评分
术前 术后 随访3个月
1 男 64 左 L1 56 9 100 90 100
2 男 29 右 T12~L1 61 6 100 90 100
3 男 44 左 L2~3 114 11 100 85 95
4 男 66 右 L5 97 5 100 65 90
5 男 19 左 L5~S1 60 11 100 100 100
6 男 31 左 L1~3 181 10 100 95 100
图1 经外侧腹膜后入路显微手术治疗腰椎椎旁肿瘤资料A：MRI T1示腹膜后椎旁肾后方类圆形肿瘤，低信号（箭头所示）；B：MRI T2示少混杂不均匀高信号，类圆形肿瘤（箭头所示）；C：增强MRI示轴位可见肾后方类圆形肿瘤，明显强化（箭头所示）；D：增强MRI示冠状位可见L1~2锥体水平类圆形肿瘤（箭头所示）；E：14 cm深度牵开器，牵开后充分暴露肿瘤；F：沿包膜内完整切除肿瘤，直径约4 cm；G：手术切口长约7 cm；H~I：术后MRI示腹膜后、肾后方肿瘤完整切除（箭头所示）
[1]
Hayasaka K, Tanaka Y, Soeda S, et al. MR findings in primary retroperitoneal schwannoma[J]. Acta Radiol, 1999, 40(1): 78-82.
[2]
Mussi C, Colombo P, Bertuzzi A, et al. Retroperitoneal sarcoma: is it time to change the surgical policy?[J]. Ann Surg Oncol, 2011, 18(8): 2136-2142.
[3]
曲腾飞，何向阳，周斌, 等. 腹膜后肿瘤手术入路及相关技巧[J]. 中华普通外科杂志, 2020, 35(6): 499-501.
[4]
Jin J, Ryu KS, Hur JW, et al. Comparative study of the difference of perioperative complication and radiologic results: MIS-DLIF (minimally invasive direct lateral lumbar interbody fusion) versus MIS-OLIF (minimally invasive oblique lateral lumbar interbody fusion)[J]. Clin Spine Surg, 2018, 31(1): 31-36.
[5]
Formica M, Zanirato A, Cavagnaro L, et al. Extreme lateral interbody fusion in spinal revision surgery: clinical results and complications[J]. Eur Spine J, 2017, 26(Suppl 4): 464-470.
[6]
Abe K, Orita S, Mannoji C, et al. Perioperative complications in 155 patients who underwent oblique lateral interbody fusion surgery: perspectives and indications from a retrospective, multicenter survey[J]. Spine (Phila Pa 1976), 2017, 42(1): 55-62.
[7]
Segawa T, Inanami H, Koga H. Clinical evaluation of microendoscopy-assisted extreme lateral interbody fusion[J]. J Spine Surg, 2017, 3(3): 398-402.
[8]
Silvestre C, Mac-Thiong JM, Hilmi R, et al. Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lumbar interbody fusion in 179 patients[J]. Asian Spine J, 2012, 6(2): 89-97.
[9]
王凯，菅凤增，孙澎, 等. 斜外侧腰椎椎间融合术对腰椎退行性疾病的间接减压效果[J]. 中华神经外科杂志, 2018, 34(7): 704-708.
[10]
Kim KT, Jo DJ, Lee SH, et al. Oblique retroperitoneal approach for lumbar interbody fusion from L1 to S1 in adult spinal deformity[J]. Neurosurg Rev, 2018, 41(1): 355-363.
[11]
Kim JS, Sharma SB. How I do it? Oblique lumbar interbody fusion at L5S1(OLIF51)[J]. Acta Neurochir (Wien), 2019, 161(6): 1079-1083.
[12]
Moskovich R, Hasan S. Oblique lateral lumbar interbody fusion: OLIF//Tender G, editor. Minimally invasive spine surgery Techniques[M]. New Orleans: Springer International Publishing AG, 2018: 97-121.
[13]
Abe K, Orita S, Mannoji C, et al. Perioperative complications in 155 patients who underwent oblique lateral interbody fusion surgery: perspectives and indications from a retrospective, multicenter survey[J]. Spine (Phila Pa 1976), 2017, 42(1): 55-62.
[14]
Fujibayashi S, Kawakami N, Asazuma T, et al. Complications associated with lateral interbody fusion: nationwide survey of 2998 cases during the first 2 years of its use in Japan[J]. Spine (Phila Pa 1976), 2017, 42(19): 1478-1484.
[15]
Zeng ZY, Xu ZW, He DW, et al. Complications and prevention strategies of oblique lateral interbody fusion technique[J]. Orthop Surg, 2018, 10(2): 98-106.
[1] 郑恢超, 王李, 童卫东, 黄彬, 田跃, 赵松, 高羽, 李凡, 刘宝华. 经肛微创手术（TAMIS）与经肛内镜显微手术（TEM）在直肠肿瘤局部切除中的应用优劣分析[J]. 中华结直肠疾病电子杂志, 2022, 11(03): 254-260.
[2] 李晓东. 翼点锁孔入路夹闭前循环动脉瘤[J]. 中华神经创伤外科电子杂志, 2022, 08(04): 255-256.
[3] 孙印臣, 卢青军, 王洪生, 程月飞, 孟文博. 一侧开颅摘除七个脑池内囊虫一例报道[J]. 中华神经创伤外科电子杂志, 2021, 07(02): 125-126.
[4] 徐佳, 张业韬, 陆小明. 自发性椎管内出血致脊髓损伤24例临床分析[J]. 中华神经创伤外科电子杂志, 2021, 07(01): 46-50.
[5] 刘元钦, 张庆露, 李翠玲, 李博, 张荣伟, 刘广存. 半-半椎板入路显微手术切除C2段脊神经鞘瘤[J]. 中华神经创伤外科电子杂志, 2020, 06(03): 172-175.
[6] 李业海, 林建浩, 叶景, 何桂录, 贠瑞瑞, 黄佛宝, 李俏, 张良. 脑室中枢神经细胞瘤显微手术入路方式的选择及疗效分析[J]. 中华神经创伤外科电子杂志, 2020, 06(03): 156-160.
[7] 谢宝树, 何科君, 李西西, 杨李轩, 黄正松, 张弩. 不同岩斜区脑膜瘤手术入路的疗效分析[J]. 中华脑科疾病与康复杂志(电子版), 2022, 12(01): 38-42.
[8] 郑津, 周迎春. 颈髓内中心型神经鞘瘤的诊断与显微手术治疗二例报道并文献复习[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(06): 375-377.
[9] 刘开东, 李劲松, 庄宗, 戴嵬, 杭春华. 前床突脑膜瘤早期硬膜外磨除前床突对视神经的保护作用[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(05): 273-276.
[10] 陈立华, 夏勇, 魏帆, 孙恺, 陈文锦, 张洪钿, 徐如祥. 前床突脑膜瘤术后并发症的分析与防治[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(03): 147-152.
[11] 赵志明, 唐兆伟, 刘运锋, 邓昌武, 张聿民. 小切口经侧裂岛叶入路显微手术治疗基底节区脑出血的临床疗效分析[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(03): 168-170.
[12] 许佳恒, 林福鑫, 康德智. 脑海绵状血管畸形相关性头痛临床特征及术后疼痛缓解的相关分析[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(02): 83-91.
[13] 沈书廷, 马飞虎, 龙翔, 牧仁, 王建武, 钱磊, 刘俊鹏, 孟宪东, 张宗林. 高血压性脑出血分型及外科治疗方法选择的探讨[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(05): 309-315.
[14] 陈立华, 孙恺, 陈文锦, 夏勇, 张洪钿, 徐如祥. 儿童髓母细胞瘤的显微手术治疗[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(04): 197-204.
[15] 丰育功, 郭品, 张洪亮, 成磊, 朱蒙, 崔振文, 王君涛, 刘学军, 李环廷, 栗世方. 症状性颈动脉狭窄的显微手术方式选择与疗效分析[J]. 中华脑血管病杂志(电子版), 2022, 16(06): 379-384.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号