|摘要||目的 总结脊柱浆细胞瘤外科诊断与治疗的临床经验.方法 回顾性分析1984年12月至2007年12月首诊并经手术治疗的脊柱浆细胞瘤27例患者的临床资料,男20例,女7例;年龄35～60岁,平均47.7岁.均主诉受累节段附近疼痛,9例伴放射痛,18例合并脊髓功能损害(Frankel B级1例、C级3例、D级14例).术前17例行CT引导下经皮穿刺脊柱病灶活检,病理均报告为浆细胞瘤.27例均经术后病理证实诊断.根据肿瘤侵犯部位选择前路、后路或前后联合入路手术.均行放疗和(或)辅助化疗.结果 5例失访,22例随访7～102个月,平均37.4个月.除1例于术后102个月死亡外,均存活并恢复正常工作与生活.术后局部疼痛或放射痛均缓解、括约肌功能障碍均恢复正常.术前脊髓功能B级、C级者于术后1年恢复至E级;D级14例中2例术后1周仍为D级,之后失访,12例恢复至E级.结论 CT引导下经皮穿刺脊柱病灶活检对诊断脊柱浆细胞瘤具有重要价值.对脊柱浆细胞瘤患者行选择性手术治疗可有效缓解疼痛,改善神经功能,恢复脊柱稳定,为进一步放疗和化疗创造有利条件.正规的放疗和化疗是巩固手术疗效的重要手段.
Objective To summarize the clinical experience in surgical diagnosis and treatment of spinal plasmacytoma. Methods Clinical data of 27 patients with spinal plasmacytoma treated with operation in Peking University Third Hospital from Dec. 1984 to Dec. 2007 were analyzed retrospectively. There were 20 males and 7 females, with the mean age of 47.7 years (range 35-60 years). All patients complained of spinal pain, and 9 patients associated with radieular pain and 18 with dysfunction of spinal cord. Seventeen cases were pathological diagnosed as plasmaeytoma before operation by CT-guided pereutaneous needle puncture biopsy. All the 27 patients were confirmed as plasmacytoma by postoperative pathological examina-tion. The patients were operated in anterior, posterior or combined approach for tumor resection and fixation according to the site of the lesion in the vertebra. Radiotherapy and/or chemotherapy were given to all pa-tients. Results 22 cases were followed up for 7-102 months, with an average period of 37.4 months. All patients survived and resumed their normal lives and work, except one died 102 months after operation. Spinal pain and radicular pain were all relieved and dysfunction of sphincters of 7 cases was corrected after operation. One case of Frankel B and 3 cases of Frankel C improved Frankel E one year after operation. Two of the 14 eases of Frankel D lost follow-up, and the other 12 cases improved to Frankel E before discharge. Conclusion As a rapid and effective method to obtain the pathological diagnosis, CT-guided percutaneous needle puncture biopsy is an important technique in the diagnosis of spinal plasmacytoma. Selective surgical treatment to patients with spinal plasmacytoma can help to relieve pain, improve neurological functions, pre-vent neural impairment, recover the function of spine, elevate life quality, and create favorable conditions to further radiotherapy and chemotherapy. Radiotherapy and chemotherapy are important treatments to consoli-date the effect of surgery.|