多节段髓内肿瘤青少年患者的临床分析  

Clinical analysis of the adolescent patients with multi-segments intramedullary spinal cord tumors

作　　者：孙建军[1] 王振宇[1] 李振东[1] 谢京城[1] 陈晓东[1] 马长城[1] 刘彬[1] 张嘉[1] 于涛[1] 林国中[1] 

机构地区：[1]北京大学第三医院神经外科,北京100191

出　　处：《北京大学学报（医学版）》2012年第4期599-601,共3页Journal of Peking University:Health Sciences

基　　金：教育部新教师基金(BSD-09-6-11);北京大学第三医院青年骨干基金(74496-01)资助~~

摘　　要：目的:前瞻性分析、评价多节段髓内肿瘤未成年患者的首发症状、二便功能和预后等临床特征,以及肿瘤部位、累及节段数和肿瘤性质等基本特性,以期了解其中规律。方法:北京大学第三医院近8年来连续性收治25例多节段(≥3个椎体节段)髓内肿瘤青少年患者,均行后正中入路显微镜下肿瘤切除术。收集患者临床资料,将二便功能状态分为4级(正常、尿频或/和便秘等轻度异常、排便困难等中度异常、失禁),以改良JOA评分系统(im-proved Japanese orthopaedic association score system,IJOA)评价神经功能状况,以IJOA分值差(术后IJOA和术前IJOA差值)评估手术效果。所有患者随访至2011年10月30日。结果:25例小于25岁的青少年患者中,男性15例,女性10例,年龄(15.3±6.83)岁。首发症状:单纯疼痛7例,疼痛伴麻木3例,疼痛伴肢体无力2例,疼痛伴步态不稳1例,单纯麻木3例,单纯肢体无力2例,跛行2例,步态不稳2例,二便功能障碍、发热、肢体变形各1例。术前IJOA评分(14.4±3.38)分。肿瘤部位:颈胸9例、颈4例、胸4例、胸腰6例、腰2例。累及节段数(4.4±1.38)节。肿瘤性质:先天性肿瘤8例(畸胎瘤6例、脂肪瘤1例、表皮样囊肿1例),星形细胞瘤7例(星形细胞瘤Ⅰ～Ⅱ级5例、弥漫性星形细胞瘤2例),室管膜瘤5例,血管性肿瘤3例,胶母和神经鞘瘤各1例。术后IJOA评分(15.5±3.31)分。结论:未成年患者的多节段髓内肿瘤多见于颈胸和胸腰段,以先天性肿瘤和星形细胞瘤多见,预后较好。Objective： To prospectively analyze the clinical features and characteristics of multi-segments intramedullary spinal cord tumors in adolescent patients. Methods： In our study, 25 consecutive adolescent patients with multi-segments intramedullary spinal cord tumors were recruited, who underwent microsurgery for the tumor using a posterior approach and were hospitalized in Peking University Third Hospital within a period of 8 years. The tumor was exposed through dorsal myelotomy. Preoperative and postoperative neurological functions were scored using the improved Japanese orthopaedic association score system （IJOA） grading system. The functional outcome was defined as postoperative IJOA score minus preoperative IJOA score. All the patients were followed-up until Oct. 30, 2011. Results： There were 15 male and 10 female adolescent patients younger than 25 years. Their mean age was （ 15.3± 6.83） years. The most common initial symptom was sensory disturbance （ including pain and/or numbness, 52%, 13/25 ）, followed by motor disturbance （including limbs weakness and gait deterioration, 24%, 6/25）, pain and motor disturbance （12%, 3/25）, as well as fever, limbs deformities, and sphincter dysfunction, respectively. The preoperative IJOA scores of the patients were （ 14.4 ± 3.38 ）. The postoperative IJOA scores of the patients were （15.5 ± 3.31 ）. The most commonly involved location was the cervicothoracic segments （36%, 9/25 ）, followed by the eonus terminalis （24%, 6/25 ）, the cervical region（ 16%, 4/25 ）, the thoracic region （ 16%, 4/25 ）, and the lumbus region （8%, 2/25 ）. The average involved segments were （4.4 ± 1.38）. The most frequent tumors were neurodevelopmental tumors （including lipoma, epidermoid cyst and teratoma） （32%, 8/25 ）, followed by astroeytomas （28%, 7/25）, ependymomas （20%, 5/25）, hemangioblastomas （12%, 3/25）, and glioblastomas and schwannomas, respectively. Conclusion： In adolescent patients with multi-segments int

关 键 词：脊髓肿瘤 预后 青少年 星形细胞瘤 

分 类 号：R739.42[医药卫生—肿瘤]