横断锁骨在臂丛神经鞘瘤切除术中的应用价值  

The value of clavicular amputation in the excision of neurilemmoma of brachial plexus

作　　者：吴广森[1] 黄迅悟[1] 常青[1] 蒋长亮[1] 彭伟[1] 冯会成[1] 

机构地区：[1]解放军总医院第二附属医院骨科,北京100091

出　　处：《中国现代医学杂志》2011年第7期872-874,共3页China Journal of Modern Medicine

摘　　要：目的评价横断锁骨在臂丛神经鞘瘤切除术中的临床应用。方法回顾自1999～2009年该院收治的21例手术治疗的臂丛神经鞘瘤患者。其中,9例采用传统的臂丛显露途径,13例在手术过程中横断锁骨扩大显露。结果术后16例患者获得随访,随访率76%,随访时间为3个月～7年。随访过程中患者无复发,传统途径臂丛神经显露的9例患者中有2例(22%)术后出现不同程度的上肢疼痛和麻木,1例患者随着切口的愈合,神经症状逐渐减轻,并在3周内完全缓解;另1例患者神经症状恢复缓慢,即使经过长期的药物治疗和物理康复,仍长期遗留患肢C6、7神经支配区皮肤麻木症状。横断锁骨扩大显露的13例患者术后神经功能均无受到影响。结论手术切除是治疗臂丛神经鞘瘤的必要手段,横断锁骨能够扩大手术视野、使肿瘤获得充分暴露,是保证瘤体的完整切除和防止术中臂丛神经副损伤的重要条件。【Objective】 To evaluate the value of clavicular amputation in the excision of neurilemmoma of brachial plexus.【Methods】 A retrospective analysis of 21 cases of brachial plexus schwannoma from 1999 to 2009 we treated in surgery,of which nine cases using the traditional means of exposure,the others using the clavicular amputation during the surgical exposure.【Results】 There were 16 cases of the patients were followed up,the rate was 76%,the follow-up time was 3 months to 7 years.During this period,all patients were no recurrence.In traditional means of brachial plexus revealed,two of nine cases（22%） with varying degrees of postoperative pain and numbness of the upper limb,the one with the healing of the incision,his neurological symptoms gradually reduced,and was a complete remission in 3 weeks;another one with a long-term drug treatment and physical rehabilitation,his neurological symptoms recovered slowly,and remaining limb C6 and C7 innervated skin numbness symptoms for all time.However,with the expanded exposure of clavicular amputation 13 cases of the patients had no any neurological dysfunctions.【Conclusion】 Surgical resection is an indispensable means in the treatment of neurilemmoma of brachial plexus,clavicular amputation can expand the surgical view and fully expose the tumor,which is an important condition to ensure a complete resection of tumor and to prevent an intraoperative injury of brachial plexus.

关 键 词：神经鞘瘤 臂丛神经 肿瘤切除 横断锁骨 

分 类 号：R739.43[医药卫生—肿瘤]