摘要
目的 :探讨胸椎椎管内外肿瘤分型及手术方法 ,以提高手术疗效。方法 :分析 13例胸椎椎管内外肿瘤 (神经纤维瘤 6例 ,恶性神经鞘瘤、脊膜瘤、骨软骨瘤、脂肪血管瘤、海绵状血管瘤、肝转移癌、肾转移癌各 1例 )患者的临床特征和影像学资料 ,根据肿瘤主体部位和涉及范围分为Ⅰ、Ⅱ、Ⅲ、Ⅳ型 ,Ⅱ、Ⅲ型采用经胸联合后正中入路手术切除 ,Ⅰ、Ⅳ型采用后正中入路手术切除。结果 :Ⅰ型 3例 ,Ⅱ型 1例 ,Ⅲ型 6例 ,Ⅳ型 3例 ;12例获肉眼下全切 ,1例恶性神经鞘瘤因胸腔内广泛浸润次全切除。患者症状均不同程度改善。结论 :将胸椎椎管内外肿瘤适当分型 ,选择相应手术方式 ,能提高肿瘤的全切除率 ,增加手术的安全性。
Objective:To evaluate the classification and surgical management of thoracic spinal tumors with both intracanalicular and extracanalicular extension.Method:13 patients with complex thoracic spinal tumors,which extending both intracanalicularly and extracanalicularly.The tumors included neurofibroma(6 patients),malignant schwannoma(1), meningioma(1), osteoenchondroma(1), cavernous angioma(1), lipoangioma(1), metastatic hepatic carcinoma(1), metastatic renal carcinoma(1).According to the results of MRI tumors are classified into 4 types:Ⅰ,Ⅱ,Ⅲ,Ⅳ type.Combined neurosurgical and thoracic technique was used in patients with Ⅱ,Ⅲ types. Laminectomy and foraminotomy was used in other patients with Ⅰ,Ⅳ types.Result:The patients were divided in 3 cases of type Ⅰ,1 case of type Ⅱ,6 cases of type Ⅲ,and 3 cases of type Ⅳ.Gross total resection was achieved in 12 patients.Subtotal removal was performed in the remaining one,who had a malignant schwannoma diffusely infiltrating left thoracic cavity. No operative death occurred.Clinical symptoms were improved in all patients.Conclusion:Tumors are classified into 4 types.With the clcassification we can choose more suitable surgical approach,which is of benefit to total and safety removal of tumors. Auther′s address\ Department of Neurosurgery, Huashan Hospital, Shanghai,200040
出处
《中国脊柱脊髓杂志》
CSCD
2000年第3期148-150,共3页
Chinese Journal of Spine and Spinal Cord
