骶管蛛网膜囊肿不同治疗方法的疗效比较  

EFFECT COMPARISON OF ARACHNOID CYSTS IN SACRAL CANAL

作　　者：王佰川[1] 邵增务[1] 吴宏斌[1] 杨述华[1] 吴永超[1] 马智林[1] 于鹏[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中国修复重建外科杂志》2010年第2期206-210,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较采用两种手术方法治疗骶管蛛网膜囊肿的疗效。方法2004年1月-2009年3月,分别采用切除棘突、椎板开窗摘除囊肿术(A组25例)和CT引导经皮穿刺医用生物蛋白胶封闭囊肿术(B组30例)治疗55例有临床症状的骶管蛛网膜囊肿患者。其中男23例,女32例;年龄15～66岁,平均42.6岁。病程6个月～15年,平均3.5年。囊肿部位:L5、S122例,S1、225例,S2、312例,S28例,骶前2例。囊肿大小为1.5cm×1.0cm～6.0cm×2.8cm。均经MRI检查确诊为骶管蛛网膜囊肿。两组患者性别、年龄、病程、囊肿大小比较差异均无统计学意义(P>0.05),具有可比性。比较两组患者围手术期及术后腰骶区疼痛和功能改善情况。结果两组患者均顺利完成手术,B组手术时间、术中出血量、住院时间均明显少于A组(P<0.01)。55例均获随访,随访时间9～61个月,平均23个月。A组术后均发生脑脊液漏,发生颅内感染2例,神经损伤3例,出现神经根刺激症状8例;B组术后出现头痛、颈项僵硬等轻度脑膜炎征象3例,低热5例;均经对症治疗后治愈(神经损伤除外)。A组术后6、7个月,B组术后7个月复查各复发1例,其中A组1例及B组1例再次行CT引导经皮穿刺医用生物蛋白胶封闭囊肿术,囊肿缩小或消失;余患者随访时均未见复发。两组患者末次随访时Oswestry功能障碍指数和视觉疼痛模拟评分均较术前明显改善(P<0.01),两组间评分改善率比较差异均有统计学意义(P<0.01)。根据评分等级,A组疼痛改善优良率为64%,B组为100%;A组功能改善优良率为24%,B组为97%。结论CT引导经皮穿刺医用生物蛋白胶封闭治疗骶管蛛网膜囊肿具有创伤小、安全可靠、疗效确切、住院时间短、费用低廉等优点,是目前治疗骶管囊肿的一种较好选择。Objective To evalute the clinical outcomes of two different surgical treatments for arachnoid cysts in sacral canal.Methods From January 2004 to March 2009,55 cases of arachnoid cysts in the sacral canal were treated by traditonal simple sacral laminectomies with resection of the cysts（group A,25 cases）and novel CT-guided percutaneous fibrin glue therapy of arachnoid cysts（group B,30 cases）.Of them,there were 23 males and 32 females,aging 15-66 years with an average of 42.6 years;the duration of symptoms was 6 months to 15 years with an average of 3.5 years.L5-S1 was involved in 22 cases,S1,2 in 25 cases,S2,3 in 12 cases,S2 in 8 cases,and presacral in 2 cases.The size of cysts was 1.5 cm×1.0 cm to 6.0 cm×2.8 cm.The MRI examination showed that all patients had cysts in the sacral canal.There were no significant difference（P0.05）in sex,ages,disease duration and cysts size between two groups.Preoperative data and postoperative lumbosacral pain and function improvement were analyzed and compared between two groups.Results All operations were performed successfully.The operative time,blood loss and hospitalization days of group B were significantly less than those of group A（P0.01）.All 55 cases were followed up from 9 to 61 months（mean 23 months）.In group A,postoperative cerebrospinal fluid leakage（25 cases）,intracranial infection（2 cases）,nerve injury（3 cases）,and nerve root irritation（8 cases）occurred;in group B,mild meningitis（3 cases）and low grade fever（5 cases）occurred.Except for nerve injury,other complications were cured after symptomatic management.During the follow-up,2 recurrent cases were found in group A and 1 case in group B.Of them,2 recurrent cases were treated with CT-guided percutaneous fibrin glue therapy of arachnoid cysts,and cysts disappeared.For two groups,there were significant differences in Oswestry functional disability index and visual analogue scale score between preoperation and postoperation（P0.01）,and in the rate of score improvement betw

关 键 词：骶管蛛网膜囊肿 生物蛋白胶 CT引导 微创技术 疗效比较 

分 类 号：R651[医药卫生—外科学]