|摘要||目的 观察脊柱骨巨细胞瘤和脊索瘤在不同类型瘤周组织中的侵袭距离,为两者手术切除范围的确定提供组织学依据.方法 将7例脊柱骨巨细胞瘤与10例脊柱脊索瘤患者的手术切除标本,按瘤周组织类型的不同,分为骨皮质组、软骨组、骨松质组、肌肉组、脂肪组和瘢痕组,分别测量各组标本肉眼边界(MSM)、组织学边界(HLM)与分子边界(MCM),并进行各边界组内比较和MSM.HLM、MSM-MCM组间比较.结果 除骨皮质组与软骨组外,其余4组边界组内比较存在统计学差异(P＜0.05).骨松质组、脂肪组、肌肉组和瘢痕组MSM-HLM,MSM-MCM差值显著大于软骨组和(或)骨皮质组同一种差值(P＜0.05),边界差值的最大值分别为11.68 mm,8.64 mm,13.08 mm和9.98 mm.结论 脊椎可被视为一个解剖间室,对局限于该间室的骨巨细胞瘤和脊索瘤,应首选全椎切除;在瘤周松质骨、椎旁肌肉和脂肪组织内行广泛性切除时,切除范围应达到肿瘤肉眼所见范围外1.3 cm,1.5 cm和1.0 cm;重视首次手术切除彻底性,复发再手术时,瘤旁瘢痕切除范围至少应达到肉眼所见范围外1.0 cm.
Objective To study the local infiltration length of spinal bone giant cell tumor and chordoma in various paratumorous tissues.Methods Surgical specimens from 7 patients with bone giant cell tumor and 10 patients with chordoma were divided into 6 groups:eortical bone group(CBG,paratumorous tissue is bone cortex with periosteum),cartilage group(CG,paratumorous tissues contain intervertebral disc,cartilage endplate and facet joint cartilage),trabecular bone group(TBG),paraspinal muscle tissue group(MTG),adipose tissue group(ATG)and scar tissue group(STG).Macroscopically margin(MSM) in the fresh specimens.histological margin(HLM)in tlle H&E sections and molecular margin(MCM)in the immunohistochemical staining sections were measured respectively.Three types of the margins of each group and MSM-HLMs.and MSM-MCMs among all groups were compared.Results Analysis of Variance comparing MSM.HLM and MCM within each group showed that there were significant differences in all groups(P＜0.05)except for CBG and CG.MSMs were significantly longer than HLMs and MCMs in TBG and MTG(P＜0.05).and MSMs were significantly longer than MCMs in ATG and STG(P＜0.05).MSM-HLMs and MSM.MCMs of TBG and ATG were significantly larger than those of CG and CBG.MSM-HLMs and MSM.MCMs of MTG and STG were significantly larger than those of CG;in addition,MSM-MCM of STG was significantly larger than CBG's.The maximum of tumor infiltration length in CBG,MTG,ATG and STG were 11.68 mm.13.08 mm,8.64 mm and 9.98 mm respectively.Conclusions Each vertebra can be seen as a compartment.so total spondylectomy is an optimal procedure when bone giant cell tumor and chordoma localized in the eompartmenL To achieve a wide resection.a 1.3 cm wide margin in paratumorous cancellous bone.a 1.5 cm wide margin in paratumorous muscle and 1.0 cm wide margin in adipose tissues are necessary.Fimt-time resection should be more aggressive and avoid tumor cell contamination.The surgical extent of salvage revision should contain paratumorous scar tissue with the margin no less than 1.0 cm.|
兰杰,刘晓光,刘忠军,等. 脊柱骨巨细胞瘤与脊索瘤局部侵袭范围的组织学研究[J]. 中华外科杂志,2008,46(23):1808-1811.