Wang Qi,Wang Jinhu,Tang Yinbing,et al.Managements of paravertebral tumors with spinal canal involvement in children:a report of 75 cases at a single center[J].Journal of Clinical Pediatric Surgery,2024,(12):1160-1165.[doi:10.3760/cma.j.cn101785-202403033-010]
椎管病灶切除在合并椎管内侵犯的椎旁肿瘤治疗中的应用:单中心75例报告
- Title:
- Managements of paravertebral tumors with spinal canal involvement in children:a report of 75 cases at a single center
- Keywords:
- Paraspinal; Neoplasms; Neuroblastoma; Spinal Canal; Neoplasm Metastasis; Surgical Procedures; Operative; Metastasectomy; Treatment Outcome
- 摘要:
- 目的 探讨合并椎管内侵犯的椎旁肿瘤的临床诊治策略,评价椎管内病灶切除在合并椎管内侵犯的椎旁肿瘤治疗中应用的安全性,以及肿瘤局部控制的有效性。方法 本研究为回顾性研究。收集2015年4月至2023年3月在浙江大学医学院附属儿童医院接受椎管内病灶切除的椎旁肿瘤合并椎管内侵犯患儿临床资料,统计和分析患儿病理类型、神经功能结局、脊柱侧弯发生情况以及肿瘤局部控制情况等,并对其中占比最多的神经母细胞瘤患儿进行亚组统计和分析。结果 共75例在本中心接受椎管内病灶切除手术的合并椎管内侵犯的椎旁肿瘤患儿纳入研究,其中神经母细胞瘤53例、其他肿瘤22例。75例患儿中,术前无神经功能障碍34例(为A组),轻度神经功能障碍26例(为B组),重度神经功能障碍15例(为C组)。A组中7例(7/34)术后出现一过性神经功能障碍,均于术后远期恢复正常;B组中2例于术后近期神经功能障碍加重,21例(21/26)于术后远期神经功能明显改善,5例神经功能无明显改善;C组12例(12/15)术后远期神经功能明显改善,其中2例恢复正常。按照手术时机分组分析显示,急诊手术组神经功能改善率高于非急诊手术组,差异有统计学意义(P=0.038)。75例患儿中,13例术后观察到脊柱侧弯(3例术前已存在脊柱侧弯),其中1级6例、2级5例、3级2例;神经母细胞瘤患儿中,有10例术后观察到脊柱侧弯(2例术前已存在脊柱侧弯),其中1级5例、2级5例;2例(2/53,3.8%)发现肿瘤残留或复发。结论 在椎旁肿瘤伴椎管内侵犯的患儿中,椎管病灶切除术对于神经功能保护和获得良好的肿瘤局部控制有着重要的临床意义。基于现代外科手术和监测技术,椎管内病灶切除术安全可行。
- Abstract:
- Objective To explore the clinical diagnoses and treatments of paravertebral tumors plus spinal canal involvement (SCI) and evaluate the safety of intraspinal lesion resection and the effectiveness of tumor local control. Methods For this retrospective study,the relevant clinical data were reviewed for 75 childrens with paravertebral tumors plus SCI undergoing intraspinal lesion resection from April 2015 to March 2023.Pathological types,neurological function outcomes,incidence of scoliosis and local tumor control were recorded and the subgroup of neuroblastoma patients with the highest proportion was statistically examined. Results There were neuroblastoma (n=53) and other tumors (n=22).There were no preoperative neurological symptoms (Group A,n=34),mild neurological dysfunction (Group B,n=26) and severe neurological dysfunction (Group C,n=15).In Group A,7(7/34) of transient postoperative neurological dysfunction normalized in the long term.In Group B,neurological dysfunction worsened immediately post-operation (n=2),21(21/26) had significant long-term improvement in neurological function and 5/26 showed no significant improvement.In Group C,12(12/15) had marked postoperative improvement in neurological function and normalized (n=2).Analysis based upon surgical timing,improvement rate of neurological function was higher in emergency surgery group than that in non-emergency surgery group with statistically significant differences (P=0.038).Among 13 cases of postoperative scoliosis,scoliosis pre-existed (n=3) and grade was Ⅰ(n=6),Ⅱ(n=5) and Ⅲ(n=2).Among 10 cases of neuroblastoma,scoliosis pre-existed (n=2) and grade was Ⅰ(n=5) and Ⅱ(n=5).Residue or recurrence occurred in 3.8%(2/53). Conclusions In children with paravertebral tumors plus SCI,resection of intraspinal lesions is essential for protecting neurological function and achieving excellent local tumor control.Based upon modern surgical techniques and monitoring technology,intraspinal lesion resection is both safe and feasible.
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备注/Memo
收稿日期:2024-3-18。
基金项目:浙江省尖兵领雁研发攻关计划项目(2024CO3181)
通讯作者:舒强,Email:shuqiang@zju.edu.cn