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目的探讨经升主动脉右侧间隙与头臂干右侧间隙行椎体切除治疗上胸椎T3、T4肿瘤的术式及疗效。方法2000年6月至2006年1月共治疗上胸椎肿瘤患者12例,男7例,女5例;年龄29～60岁,平均42岁。原发性肿瘤8例,转移瘤4例。T3肿瘤4例,T4肿瘤6例,T3,4肿瘤2例。采用改良的经胸骨柄入路,经升主动脉右侧间隙和头臂干右侧间隙显露椎体肿瘤病灶。采用刮除方式切除肿瘤3例(巨细胞瘤1例,嗜酸性肉芽肿1例,动脉瘤样骨囊肿1例),余采用整块切除方式切除。椎体间采用自体髂骨或骨水泥进行重建,颈椎前路带锁钛钢板内固定。脊髓损伤程度按Frankel分级标准评定。结果术中发生血压下降和(或)气道阻力增加6例。术后随访4～66个月,平均28.6个月。12例患者术后神经功能均有改善。3例植骨患者植骨均融合。1例T3骨肉瘤患者和3例转移瘤患者术后10￣18个月因全身多处转移,衰竭死亡。1例巨细胞瘤患者采用刮除方式切除后10个月局部复发。结论经升主动脉右侧间隙和头臂干右侧间隙行T3、T4椎体切除重建内固定术可获得良好的暴露,近期疗效满意,适用于脊髓前方存在压迫的上胸椎T3、T4椎体肿瘤。
Objective To investigate the surgical procedure and effect of the right thoracic T3, T4 tumor treated by the right lateral interspace of the ascending aorta and the right truncus of the trunk. Methods From June 2000 to January 2006, 12 cases of thoracic tumors were treated, including 7 males and 5 females, aged 29-60 years (average 42 years). 8 cases of primary tumors, 4 cases of metastases. 4 cases of T3 tumor, 6 cases of T4 tumor, 2 cases of T3 and 4 tumors. The use of improved transimuscular approach, the right aortic astigmatism and right trochanteric space exposed vertebral tumor lesions. Removal of the tumor using curettage in 3 cases (1 case of giant cell tumor, eosinophilic granuloma in 1 case, aneurysmal bone cyst in 1 case), I use the whole excision resection. Vertebral body using autologous iliac or bone cement reconstruction, anterior cervical locking titanium plate fixation. The extent of spinal cord injury was graded according to the Frankel criteria. Results Intraoperative hypotension and / or airway resistance increased in 6 cases. The patients were followed up for 4 to 66 months with an average of 28.6 months. All 12 patients had improved neurological function. Three patients with bone graft were all fusion. One patient with T3 osteosarcoma and 3 patients with metastatic disease died of multiple failure and death due to multiple systemic metastases 10 to 18 months after operation. One case of giant cell tumor patients with local recurrence 10 months after removal of the curettage. Conclusion The right posterior ascending aorta and right trochanter of the trunk right trochanteric line T3, T4 vertebroplasty and reconstruction of internal fixation to obtain a good exposure, the recent satisfactory results for the spinal cord in front of oppression of the upper thoracic T3, T4 vertebral body Tumor.