[Clinical application of anterior thoracoscopically assisted surgery with posterior one-stage total en block spondylectomy for thoracic spinal tumor].
Zhongguo Gu Shang. 2017 Sep 25;30(9):857-860
Authors: Xue W, Guan XL, Wang ZP, Hao ZY, Liu L, Qian YW
OBJECTIVE: To research the clincial results and feasibility of anterior thoracoscopically assisted surgical procedure (TAS) with posterior one-stage whole en block spondylectomy(TES) for thoracic spinal tumour.
METHODS: From October 2014 to January 2016, Four sufferers with thoracic spinal tumour had been handled by anterior thoracoscopically assisted surgical procedure with posterior one-stage whole en block spondylectomy. There have been 2 males and a couple of females, aged 16, 35, 46, 60 years. Programs of illness had been 1, Four, 6, 9 months. The tumor occurred at T?, T?, T??? phase in 1 case respectively, at double T7/T8 segments in 1 case. Preoperative visible analogue scores(VAS) had been Four, 5, 6, Eight factors. Frankel grade of neurologic operate was grade B in 2, D in 1, and E in 1. SF-36 high quality of life scores had been 38, 65, 35, 29 factors, together with 2 instances of main spinal tumors, 2 instances of metastatic spinal tumors. In response to the classification of Tomita, 1 case was kind III, 2 instances had been kind IV, 1 case was kind VI. And in keeping with the WBB staging, Four-9/ABCD was in 2 instances, 5-Eight/ABC compliated with 1-Three was in 1 case, 6-7/ABC was in 1 case. Surgical process: With lateral place, the thoracoscope channel was inserted. The concerned intervertebral vessels and corresponding intercostal vessels had been ligated, whereas the prevertebral giant vessels had been utterly separated and guarded. The entrance halves of superior and inferior concerned vertebral discs had been eliminated. Then the sufferers had been modified to inclined place, posterior one-stage whole en block spondylectomy, titanium cage bone graft (allograft bone), pedicle screw fixation had been carried out.
RESULTS: The entire operations had been profitable and the sufferers had been adopted up for 34, 10, 11, 12 months. Pleural effusion occurred in 1 case after operation, and pleural closed drainage was performed. All incisions acquired main therapeutic; and all sufferers confirmed vital ache reduction (P<zero.005), with the VAS rating reducing to 2(2 instances) and three(2 instances) scores, 2 months after surgical procedure. No nerve purposeful damage aggravated. SF-36 high quality of life rating clearly improved with postoperative scores for 88, 92, 71, 80 at Three months after operation. No recurrent vertebral tumor, inside fixation lossening or breakage was discovered at follow-up factors of three, 6, 12 months. One affected person with lung most cancers died of a number of organ failure at 11 months after operation.
CONCLUSIONS: With anterior TAS, vertebral anterior vessels, intervertebral blood vessels, intercostal vessels had been efficiently separated or ligated, intraoperative bleeding was successfully managed, lung and esophagus had been successfully protected, and the tumor obtained broad excision. Anterior TAS and one-stage posterior TES might considerably scale back the surgical trauma and the danger of surgical procedure.
PMID: 29455490 [PubMed – in process]