一期显微手术切除椎管内外沟通性哑铃型肿瘤(附13例分析)  

One-stage microresection for intra-and extra-spinal dumbbell-shaped tumor:report of 13 cases

作　　者：陈赞[1] 菅凤增[1] 叶明[1] 王亚冰[1] 凌锋[1] 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国微侵袭神经外科杂志》2007年第11期491-493,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨椎管内外沟通性哑铃型肿瘤的临床特点和外科治疗策略。方法回顾性分析13例椎管内外沟通性哑铃型肿瘤病人的临床资料。肿瘤位于颈椎8例,胸椎1例,腰椎4例。肿瘤分期:Ⅲ期12例,Ⅳ期1例。采用联合入路(后正中入路+前外侧入路)8例,经后正中入路5例;均行半椎板切除。1例Ⅳ期病人切除肿瘤后采用后路钉棒系统固定融合病变节段。结果本组肿瘤均完全切除。肿瘤性质:神经鞘瘤11例,恶性神经鞘瘤1例,神经节细胞瘤1例。术后感觉麻木面积扩大5例,肢体运动功能改善8例。随访6个月～3年,平均18个月。无肿瘤复发,无脊柱畸形发生。结论采用一期显微手术可以切除大多数椎管内外沟通性哑铃型肿瘤,行半椎板切除可以减少对脊柱稳定性的影响,应用囊内分块切除技术可以减少对肿瘤邻近解剖结构的损伤。Objective To investigate the clinical features, and surgical treatment strategy of intra- and extra-spinal dumbbell-shaped tumor. Methods Clinical data of 13 patients with intra- and extra-spinal dumbbell-shaped tumor were retrospectively studied. The tumor was located in the cervical spine in 8 cases, thoracic spine in 1, and lumber spine in 4. The tumor was in stage Ⅲ in 12 cases and Ⅳ in 1. The tumor was resected via posterior midline approach combined with anterior lateral approach in 8 cases, and via posterior midline approach alone in 5. Semi-laminectomy was performed in all the cases. A screw fixation via posterior approach was performed for fusion of lesion segments after tumor resection in 1 case. Results Tumor was totally resected in all the cases. Histological types of the tumors included schwannoma in 11 cases, malignant schwannoma in 1, and paraganglioma in l. The numbness area was enlarged in 5 cases, and the motor function improved in 8. The patients were followed-up for 6 months to 3 years with an average of 18 months. No tumor relapse and spinal malformation were found. Conclusion Most cases of dumbbell intra- and extra-spinal tumor can be treated with one-stage microsurgery. The stability of the spine can be maintained with semi-laminectomy, and the damage of the adjacent anatomic structures can be avoided by intracapsular piece-by-piece resection of the tumor.

关 键 词：哑铃型肿瘤 显微外科手术 一期手术 半椎板切除 

分 类 号：R739.4[医药卫生—肿瘤]