超早期显微外科手术治疗先天性神经管畸形56例  

Effect of Ultra Early Microsurgery Treatment on Congenital Neural Tube Defect in 56 Children

作　　者：崔志强[1] 修波[1] 萧凯[1] 罗天宝[1] 段宏宇[1] 

机构地区：[1]清华大学玉泉医院脊髓神经外科,北京100049

出　　处：《实用儿科临床杂志》2010年第23期1806-1807,1827,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的评价先天性神经管畸形(CNTD)超早期显微外科治疗的效果。方法 2004年6月-2009年1月本院收治的56例CNTD患儿均行神经系统检查和MRI检查,随后行显微外科手术治疗。手术方法:麻醉成功后,取俯卧位沿脊柱后正中切口,打开骨性椎管暴露硬脊膜,脑膜剪剪开硬膜,在神经电生理的配合下分离出马尾神经,松解脊髓圆锥,再游离终丝,最后完整修补缺损硬脊膜,选择性切断增粗变短的终丝,以达到解除脊髓栓系、降低脊髓张力的目的。术后疗效按治愈、好转、无变化和加重进行评定。结果按Kirollos术中松解分级评定方法,53例(94.6%)达到1级全部松解,2例(3.5%)达到2级部分松解,1例(1.8%)为3级未松解。手术近期疗效:治愈15例(27%),排便、排尿等功能恢复正常;好转32例(57%),排尿、排便功能及下肢肌力有一项明显改善;无变化9例(16%),与术前症状一致;无恶化病例。结论超早期显微外科手术是治疗CNTD的有效方法。Objective To evaluate the eariler microsurgery treatment effect on congenital neural tube defect （CNTD）. Methods Fifty - six children with CNTD hospitalized in Yuquan Hospital,Tshinghua University from Jun. 2004 to Jan. 2009 had completed nervous system and the MRI examination,at the same time,microsurgical operation were put in practice. After being anaesthetized successfully, the median inci- sions of the participants at the back were made, then vertebrate canals and spinal dura were exposed and cut open. Finally,cauda equian separation,eonus medullaris neurolysis and terminal fila excision were carried out with the help of electrophysiological monitoring. The therapeutic assessment after operation were evaluated as cures,improved cases,and cases without change or aggravated. Results According to Kirollos grades assessment,53 cases （94.6%） achieved grade Ⅰ （completely loosened） , 2 cases （3.5%） did grade Ⅱ （ partly loosened） , 1 case（ 1.8% ） did grade Ⅲ （ （ no effective）. Short - term effects after operation were as followed： 15 cases （27%） cured and their physiological function, such as defecation and urination, recovered completely. Thirty - two cases （57%） improved, one of their physiological function, such as defecation, urination and muscular strength of lower limbs were ameliorated dramatically. And 9 cases （ 16% ） had no effect, their symptoms didn＇t improved. No case showed aggravated. Conclusion That ultra - early time microsurgery treatment for CNTD is effective.

关 键 词：先天性神经管畸形 显微手术 超早期 

分 类 号：R726.5[医药卫生—儿科]