儿童脂肪脊髓脊膜膨出外科治疗的探讨  

Surgical methods and techniques of lipomyelomeningocele in children

作　　者：黄省利[1] 师蔚[1] 张立根[2] 

机构地区：[1]西安交通大学医学院第二附属医院神经外科,710004 [2]西安市儿童医院外科

出　　处：《中华外科杂志》2010年第10期750-752,共3页Chinese Journal of Surgery

摘　　要：目的 探讨脂肪脊髓脊膜膨出外科治疗的方法和技巧.方法 自2004年1月至2007年3月共收治脂肪脊髓脊膜膨出25例,年龄2个月～6岁,均行磁共振和肌电图检查,给予手术治疗.并采用Hoffman脂肪脊髓脊膜膨出功能分级进行疗效判定.结果 25例患者切口均一期愈合.随访1～4年,18例术前神经功能正常者,术后神经功能也正常.7例有神经症状者,术后神经症状改善,其中4例术后功能分级提高,另3例功能分级无变化而有症状改善.所有患者无再栓系的形成.结论 脂肪脊髓脊膜膨出采取切除大部脂肪组织,缝合脂肪表面软脊膜,切断终丝等方法和技巧,显著提高了疗效.Objective To investigate the methods and techniques of surgical treatment of lipomyelomeningocele in children. Methods From January 2004 to March 2007, twenty-five children aged from 2 months to 6 years with lipomyelomeningocele were operated on. Magnetic resonance imaging and electromyogram had been conducted to all the patients. The operation was composed of subtotal excision of lipomas, suture of spinal pia mater and resection of terminal filum. The results of treatment were evaluated by Hoffman＇s functional grading scheme for lipomyelomeningocele. Results After operation, all the patients recovered and were released from hospital. No complications, including cerebrospinal fluid leakage and infection occured. During the follow-up of 1-4 years, 18 asymptomatic patients＇ neurological function were normal and there was no deterioration, 7 symptomatic patients improved. Among the 7 patients,4 patients had higher function grades compared with their preoperative assessments, and the other stayed in the same grades but with symptoms improved. Magnetic resonance imaging showed no tethered cord in all the patients postoperatively. Conclusions For lipomyelomeningocele, early operation should be performed to prevent the development of neurological defect. It is safe and effective to adopt subtotal excision of lipomas, suture of spinal pia mater, and resection of terminal filum.

关 键 词：脊髓脊膜膨出 脂肪瘤 手术 儿童 

分 类 号：R726.5[医药卫生—儿科]