椎管内肿瘤的显微外科手术治疗  

Microsurgical treatment of intraspinal tumor

作　　者：刘洪泉[1] 杜秀玉[1] 王立忠[1] 殷尚炯[1] 王志明[1] 王洪生[1] 赵佩林[1] 李国英[1] 

机构地区：[1]解放军251医院神经外科,张家口075000

出　　处：《中国微侵袭神经外科杂志》2011年第11期502-504,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的总结不同脊髓节段的椎管内肿瘤的手术治疗方法。方法回顾性分析351例椎管内肿瘤的临床资料。所有病人均行显微手术治疗,采用后外侧肌间入路2例;半椎板入路243例,其中切除骨复位、椎管重建93例;旁正中侧方入路7例;全椎板入路99例,其中全椎板复位、椎管重建67例,去椎板减压32例。结果肿瘤全切除333例(94.9%),次全及部分切除18例(5.1%)。术后按Frankel标准评定疗效,优良298例,显效47例,差6例。229例随访1～9年,影像学复查均未见椎管狭窄及滑脱,肿瘤复发16例。结论根据肿瘤不同性质、不同节段及与脊髓相对位置,采用个性化显微手术方法,既能保证肿瘤切除,又能维护脊柱稳定。Objective To explore the surgical method for intraspinal tumor in different segments of the spinal cord. Methods Clinical data of 351 patients with intraspinal tumor were analyzed retrospectively. All the patients underwent microsurgical treatment via the following approaches, including posterolateral intermuscular approach in 2 patients, hemilaminectomy approach in 243, of whom bone restoration and vertebral canal reconstruction in 93, paramedian lateral approach in 7, laminectomy approach in 99, of whom the vertebral plate restoration and vertebral canal reconstruction in 67 and laminectomy decompression in 32. Results Total tumor resection was achieved in 333 patients （94.9%）, and subtotal and partial resection in 18 （5.1%）. The therapeutic effect was evaluated according to Frankel criteria postoperatively, good recovery was achieved in 298 patients, effective treatment in 47 and bad recovery in 7. Two hundred and twenty-nine patients were followed up for 1 to 9 years. There was no spinal stenosis and slippage by imaging reexamination, and tumor recurred in 16 patients. Conclusions According to the nature of tumor, segment of the spinal cord where the tumor located at and tumor position relative to the spinal cord, individualized treatment protocols should be adopted, which can not only ensure the tumor resection but also maintain spinal stabilization.

关 键 词：脊髓肿瘤 后外侧肌间入路 半椎板入路 旁正中侧方入路 全椎板入路 

分 类 号：R739.42[医药卫生—肿瘤] R651.2[医药卫生—临床医学]