胸椎骨肉腫の再発例に対して脊髄も含めて腫瘍脊椎骨全摘術を施行した1例

Complete Segmental Spinal Resection for Recurrent Thoracic Osteosarcoma. Case Report

　胸椎骨肉腫の再発例に対して，これまでに施行された化学療法，放射線照射のいずれにも効果がなかったことから，手術による腫瘍の完全切除のみが延命につながる唯一の方法と考えた．本例では既に2カ月も完全脊髄麻痺の状態であったこと，また，脊髄を犠牲にして70Gyもの大量重粒子照射を施行していたことから，脊髄機能回復の見込みは全くないと判断し，やむを得ず脊髄を切断したうえで，脊髄も含めて第1～5胸椎の腫瘍脊椎骨全摘術を行い，一塊とした腫瘍の広範切除を施行した．術後，呼吸器合併症を繰り返したが，ファイバーによる吸痰と理学療法で克服し，車椅子移動まで可能となった．しかし，多発性肺転移により6カ月後に死亡した．

　A 21-year-old man was referred to our hospital because of recurrent thoracic osteosarcoma. Chemotherapy and radiation therapy at the previous hospitals had not been effective, and the tumor was growing rapidly. We concluded that the only effective life-saving therapy was complete surgical excision of the tumor. He already had complete paralysis of bilateral lower extremities for 2months, and a high radiation dose (70 Gy) was done at the sacrifice of his spinal function. Since there was no possibility of recovery of spinal cord function, complete segmental spinal resection (total en bloc spondylectomy) from T1 to T5 was performed, and the spinal cord was resected at that level. En bloc excision of the tumor with a wide margin was achieved. Pulmonary complications which were repeated after the surgery, were overcome by intensive care and rehabilitation. The patient became to able to move about in a wheelchair 3months after surgery, but he died of multiple lung metastases 6months after surgery.