摘要
目的探讨颈段椎管内外沟通性肿瘤显微手术疗效。方法回顾性分析2013年1月至2017年2月蚌埠医学院第一附属医院神经外科15例颈段椎管内外沟通性肿瘤患者的临床资料。肖氏改良分区分期：Ⅰ期6例，Ⅱ期5例，Ⅲ期3例，Ⅳ期1例。手术方式：后正中半椎板入路9例，其中内固定2例；后正中入路棘突椎板复合体原位回植椎管成形术3例；颈前入路3例，其中内固定1例。术后采用椎管MRI检查评价肿瘤的切除情况，采用脊柱CT三维重建或脊柱X线检查评价脊柱稳定情况，采用Frankel分级标准评价患者的脊髓功能恢复情况。结果本组15例肿瘤均在显微镜下一期全部切除。肿瘤性质：神经鞘瘤14例，神经节细胞瘤1例。术后无脑脊液漏及切口感染。术后Frankel分级显示，患者脊髓功能恢复D级4例，E级11例。随访1～24个月，平均13个月，无肿瘤复发及脊柱失稳。结论颈椎椎管内外沟通性肿瘤应选择合适的手术入路，显微镜下可一期全切肿瘤，必要时行相应的椎体重建和脊柱内固定术以维持脊柱稳定性。
Objective To explore the curative effect of microsurgical treatment of cervical intra- and extra-spinal tumors.Methods The clinical data of 15 patients with cervical intra-and extra-spinal tumors in Department of Neurosurgery, the First Affiliated Hospital of Bengbu Medical College from January 2013 to February 2017 were retrospectively analyzed. According to Shaw′s tumor stage： 6 cases in stage Ⅰ, 5 cases in stage Ⅱ, 3 cases in stage Ⅲ, and 1 case in stage Ⅳ. About the surgical methods： 9 cases were treated via posterior median semi-laminectomy approach, of which were internal fixation in 2 cases, and via posterior median approach spinous process and vertebral plate complex orthotopic replantation to spinal canal plasty in 3 cases, other 3 cases were operated via anterior cervical approach, including internal fixation in 1 case. After the surgery, vertebral canal MRI was adopted to evaluate the tumor, and CT three-dimensional reconstruction or X-ray of the spine was used for assessing the stability of spinal column, and Frankel grading standard was employed to evaluate the recovery of spinal cord function.Results The tumors were totally resected in the first stage with the help of a microscope. Histological types of the tumors included schwannoma in 14 cases, gangliocytoma in 1 case. There was no leakage of cerebrospinal fluid and infection of incisional wound after operations. After the surgery, Frankel grading standard was adopted to assess the recovery of the spinal cord function, and the results showed grade D in 4 patients and grade E in 11 patients. All patients were followed-up for 1 to 24 months with an average of 13 months without tumor recurrence and spinal instability.Conclusion Appropriate surgical approach should be selected to treat the cervical intra- and extra-spinal tumors, totally resection of the tumor could be achieved under the microscope, and the corresponding vertebral reconstruction and spinal fixation should be used to maintain spinal stability if necessary.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第23期1805-1808,共4页
National Medical Journal of China
关键词
脊髓肿瘤
显微外科手术
颈椎
Spinal cord neoplasms,Microsurgery,Cervical vertebrae
