Boriani S, Biagini R, De Iure F, Bandiera S, Di Fiore M, Bandello L, Malaguti M C, Picci P, Bacchini P
Divisione di Ortopedia e Traumatologia, Ospedale Maggiore, Bologna.
Chir Organi Mov. 1998 Jan-Jun;83(1-2):53-64.
With the purpose of clarifying the limits of resection surgery (en bloc excision) for the treatment of bone tumors of the spine, the authors report the indications and results of 43 operations. This series was homogeneous in terms of oncological and surgical staging, as well as with regard to surgical method used and anaesthesiology. Three different types of surgery were performed: en bloc resection of tumors of the body (sectors 5-9 or 4-8 depending on the WBB staging system), of the posterior arch (sectors 10-3) or characterized by eccentric growth (sectors 2-5 or 8-11). The surgical margins were histologically studied in all of the cases: based on the evaluation and on histological diagnosis further chemo- and/or radiation therapy were decided on. Long-term follow-up was obtained for all of the cases (from 6 to 153 months, mean 30 months; 26 cases followed for more than 24 months). Six of the patients died as a result of the disease from 10 to 28 months after resection. There were 4 local recurrences, 4 pulmonary metastases, and 5 metastatic disseminations to the skeleton and to other tissues observed in 11 patients. At final follow-up 33 patients (77%) were thus disease-free (32 continually), in excellent condition, and capable of living a normal life. Complications and treatment are also reported. A careful study of the neoplasm, an appropriate selection of the patients based on diagnosis and histological staging, a knowledge of the natural progression of bone neoplasms and of the surgical anatomy of the vertebral column, the application of suitable measures of anaesthesiological control, allow for a correct cost/benefit evaluation of this type of surgery as compared to oncological methods that are less effective but more diffused. On the basis of these considerations indications for en bloc resection in tumors of the spine are defined.
为明确脊柱骨肿瘤切除手术（整块切除）的限度，作者报告了43例手术的适应证及结果。该系列在肿瘤学和手术分期方面，以及所采用的手术方法和麻醉学方面具有同质性。实施了三种不同类型的手术：椎体肿瘤整块切除（根据WBB分期系统为5 - 9区或4 - 8区）、后弓肿瘤整块切除（10 - 3区）或偏心生长型肿瘤整块切除（2 - 5区或8 - 11区）。所有病例均对手术切缘进行了组织学研究：根据评估结果和组织学诊断决定进一步的化疗和/或放疗。所有病例均获得了长期随访（6至153个月，平均30个月；26例随访超过24个月）。6例患者在切除术后10至28个月因疾病死亡。11例患者中观察到4例局部复发、4例肺转移以及5例骨骼和其他组织的转移性播散。在末次随访时，33例患者（77%）无疾病（32例持续无病），状况良好，能够正常生活。还报告了并发症及治疗情况。对肿瘤进行仔细研究，根据诊断和组织学分期适当选择患者，了解骨肿瘤的自然进展和脊柱的手术解剖结构，应用合适的麻醉控制措施，与效果较差但应用更广泛的肿瘤学方法相比，可对这类手术进行正确的成本效益评估。基于这些考虑，明确了脊柱肿瘤整块切除的适应证。
