摘要
目的分析脊髓脊膜膨出患儿合并其他神经系统疾病类型，完善治疗策略。方法回顾性分析北京大学第一医院2005年1月至2013年6月收治的有完整临床资料的69例脊髓脊膜膨出患儿。术前均行脊柱磁共振（MRI）检查，头部采用B超、CT、MRI或联合以上2种方法检查。手术常规于显微镜下行膨出包块切除、椎管探查、脊髓栓系松解、脊髓脊膜膨出修补术，并对比MRI所见与术中探查所见。结果术前脊柱MRI检查发现合并圆锥低位59例，脊髓空洞24例，脊髓中央管轻度扩张20例，脊髓纵裂畸形14例，椎管内囊肿、椎管内胎肪瘤各6例。头部影像诊断脑积水19例，其中合并小脑扁桃体下疝5例。术中发现合并脊髓纵裂畸形17例，椎管内脂肪瘤8例，椎管内囊肿6例，1例椎管内畸胎瘤。合并脑积水的患儿均发现有脊髓中央管扩张或脊髓空洞，61例（占88．4％）病例合并1种以上其他畸形。所有患儿均获得随访，随访时间为4—71个月，平均23．8个月。所有患儿均未出现新症状。结论脊髓脊膜膨出通常合并其他神经系统畸形，术前行全脑及全脊髓影像检查很重要，同时术中应仔细探查，避免遗漏病变。
Objective To analyze the categories of co-existed nervous system anomalies in children with meningomyelocele in order to consummate the treating strategy for meningomyelocele. Methods Sixty-nine children who had complete clinical data diagnosed as meningomyelocele in Department of Pediatric Surgery, Peking University First Hospital from Jan. 2005 to Jun. 2013, were retrospectively analyzed. Preoperative spinal MRI was routinely performed. Ultrasonagraphy, CT, MRI or combination of the 2 measures were adopted to evaluate the brain. Microscopically excision of the sac, exploration of the spinal canal, brisement of the tethered cord and meningomyelocele repair were routine operation procedures. Other lesions detected during operation were treated accordingly. MRI findings and intraoperative findings were also compared. Results Preoperative spinal MRI found 59 cases of cone bit,24 cases of syringomyelia, 20 cases of mild syringomyelus, 14 cases of diastematomyelia,6 cases of intraspinal cyst,6 cases of intraspinal lipoma. Nineteen cases of hydrocephalus were diagnosed by iconography, among which 5 cases complicated with caudal herniation of cerebellar tonsils. Seventeen cases of diastematomyelia,8 cases of intraspinal lipoma,6 cases of intraspinal cyst were detected and treated during operation. Three cases of intraspinal lipoma and 3 cases of osseous diastematomyelia were ignored by preoperative MRI reports. Two cases of intraspinal epidermoid cyst were misdiagnosed as general cyst. One case of teratoma who was not found on MRI was detected by operation and resected. Syringomyelus or syringomyelia was found in all the children complicated with hydrocephalus. Sixty-one cases（88.4% ） among the 69 cases complicated with other nervous system anomalies. All of patients were followed up for 4 -71 months, averaged 23.8 months. All of patients had no new symptom. Conclusions Children with meningomyelocele often complicate with multiple nervous system anomalies. Preoperative brain and entire spinal iconography, together with thorough intraoperative exploration, are very important so as to avoid omission the co-existed lesions during operation.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2014年第1期64-66,共3页
Chinese Journal of Applied Clinical Pediatrics
关键词
脊髓脊膜膨出
合并症
诊断
Meningomyelocele
Complication
Diagnosis
