摘要
目的：总结颈椎朗格罕斯细胞组织细胞增生症（Langerhans cell histiocytosis，LCH）的诊断和治疗经验。方法：我院自1997年10月至2007年9月诊治颈椎LCH患者35例，男性24例，女性11例；年龄1．5—41岁，其中未成年（〈18岁）患者25例，成年（≥18岁）患者10例。累及寰枢椎15例，累及下颈椎20例；单发病变（EG）30例，多发病变5例。33例为病理诊断（29例在CT引导下行病灶穿刺活检，1例皮肤病灶取活检，3例手术时病理检查），2例为临床诊断。23例神经功能损害不明显、颈椎无严重畸形和不稳的患者选择保守治疗，其中单纯局部制动保护5例，制动加放射治疗13例，制动加化学治疗3例，制动加放、化疗2例。12例选择手术治疗，其中3例诊断不明确，4例颈椎明显后凸畸形，3例神经损害症状明显，2例颈椎不稳。随访患者临床症状及影像学的变化。结果：35例患者影像学检查病灶均表现为溶骨性破坏，19例累及附件结构及椎旁软组织。CT穿刺活检病理结果阳性符合率96．7％（29／30）。30例获得随访，平均随访53．5个月，均未见复发。保守治疗的20例患者CT和X线片均见原病灶处骨质明显修复，11例骨质压缩超过50％的脊椎相对高度有较明显恢复。手术治疗的10例患者神经损害症状均缓解，畸形均有所改善，植骨均融合。结论：经CT引导下穿刺活检是确诊LCH的首选方法，非手术治疗（局部制动、放疗及化疗）可获得良好疗效；但对于难以确诊、明显脊柱不稳、严重颈椎畸形和／或严重神经损害病例宜选择手术治疗。
Objective：To sum up the clinical experience in diagnosis and treatment of cervical Langerhans cell histiocytosis（LCH）.Method：Thirty-five patients with LCH of cervical spine had been diagnosed and treated in our hospital from 1997 to 2007,including 24 males and 11 females.Their age ranged from 1.5-41 years. There were 25 children and 10 adults.Lesions involved in atlantoaxial region in 15 cases and in subaxial cervical spine in 20 cases.There were 30 cases with single lesion and 5 cases with multiple lesions.Pathologic diagnosis was achieved in 33 cases （29 cases by CT-guided percutaneous biopsy,1 by skin biopsy and 3 by postoperative pathology） and 2 cases obtained clinical diagnosis.Conservative treatments were performed to 23 patients who had no severe neurological deficit, deformity or instability.There were 5 cases treated by simple immobilization,13 cases by immobilization and radiotherapy,3 cases by immobilization and chemotherapy,2 cases by immobilization,radiotherapy and chemotherapy.12 cases underwent the operation including 3 cases with suspected malignancy,4 cases with marked kyphosis,3 cases with obvious neurological deficit and 2 cases with instability.The changes of symptoms and radiograph were studied at the follow-up.Result：The radiographic results of all patient showed osteolytic bony lesions,the lesion extended to the pedicle,lamina or paravertebral soft tissue in 19 cases.The positive rate of pathology by CT-guided percutaneous biopsy was 96.7%（29/30）.Thirty cases （85.7%） were followed up on an average of 53.5 months （range,12-130 months） without recurrence.In the 20 conservative cases,X-ray and CT scan showed obvious bone reconstruction.Of the 11 cases with severe bony collapse （〉50%）,the height of the vertebra obviously increased.All of the 10 cases who underwent the operation treatment obtained neurological deficit recovery,kyphosis deformity reduction and grafts fusion.Conclusion：CT-guided pereutaneous biopsy is the first choice to make final diagnosis for suspected cervical LCH cases.Conservative treatments including immobilization,radiotherapy and chemotherapy can provide a good result in most patients.However,operation should be considered to those cases with undefined diagnosis,obvious instability and/or severe kyphosis with/without neurological deficit.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2009年第6期431-436,共6页
Chinese Journal of Spine and Spinal Cord
