高位颈段椎管内肿瘤的显微手术治疗  

Microsurgical treatment of tumors in upper cervical spinal canal

作　　者：邓勇[1] 吴习威[1] 费勤勇[1] 丁希[1] 吴德俊[1] 

机构地区：[1]武警安徽总队医院神经外科,合肥230041

出　　处：《中国微创外科杂志》2007年第7期651-652,共2页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨高位颈段椎管内肿瘤显微手术技巧和疗效。方法 1990年1月～2005年12月,采用后正中入路显微手术治疗81例高位颈段椎管内肿瘤。髓外硬脊膜下及硬膜外肿瘤神经纤维瘤、神经鞘瘤73例,脊膜瘤3例全切除;室管膜瘤3例全切除,星形细胞瘤2例行大部分切除。结果 按George等的评估方法：术后恢复良好75例,症状改善4例,2例无明显改善,无死亡。52例随访3个月～3年,（8.5±1.5）月。15例术后3个月MR检查未见肿瘤残存或复发;32例术后6个月颈椎正侧位及张口位片检查未见脊柱骨性结构变形,脊柱稳定性好。髓内肿瘤复发3例。结论 高位颈段椎管内肿瘤一旦诊断明确,应尽早显微手术。应用显微操作,重视微创原则,保护重要组织,维持或重建脊柱稳定,高位颈段椎管内肿瘤手术可获得良好效果。Objective To explore surgical techniques and curative effects of microsurgical treatment for tumors in upper cervical spinal canal. Methods A total of 81 cases of tumors in upper cervical spinal canal had received microneurosurgery from January 1990 to December 2005. The operation was conducted through a posteromedial approach. A total tumor resection was performed in 73 cases of neurofibroma or neurilemmoma, 3 cases of spinal meningioma, and 3 cases of ependymoma. A subtotal tumor resection was conducted in 2 cases of astrocytoma. Results A complete recovery was achieved in 75 cases, an improvement of symptoms was achieved in 4 cases, and no improvement in 2. No death was encountered. Follow-up observations were carried out in 52 cases for 3 months - 3 years （8.5 - 1.5 months）. MRI examinations 3 months after operation in 15 cases found no residual or recurrent tumor. X-ray radiography under anteroposterior, lateral, and open-mouth view 6 months after operation in 32 cases showed no spinal deformation and good vertebral stability. Recurrence of intramedullary tumor was seen in 3 cases. Conclusions As long as tumors in upper cervical spinal canal are diagnosed, a microsurgical treatment should be given as early as possible. Appropriate selection of surgical approach, skillful microsurgical techniques in accordance with pathological types of lesions, and principles of minimal invasion are critical for the operation safety.

关 键 词：高颈段 椎管肿瘤 显微手术 

分 类 号：R739.4[医药卫生—肿瘤]