颈侧入路切除颈部椎管内外哑铃形神经源性肿瘤  

Lateral cervical approach for resection of cervical dumbbell-shape neurogenic tumors

作　　者：钱海鹏[1] 万经海[1] 李学记[1] 刘绍严[2] 

机构地区：[1]中国医学科学院肿瘤医院神经外科,100021 [2]中国医学科学院肿瘤医院头颈外科,100021

出　　处：《中华外科杂志》2012年第12期1091-1095,共5页Chinese Journal of Surgery

基　　金：北京希望马拉松专项基金资助项目（LC2011A06）

摘　　要：目的探讨颈侧入路切除颈椎管内外哑铃形神经源性肿瘤的适应证及术式特点。方法回顾分析2005年10月至2011年10月14例颈椎管内外哑铃形神经源性肿瘤患者的临床资料，患者男性8例，女性6例，年龄11—60岁。影像学证实为椎管内外哑铃形生长的肿瘤，肿瘤最大径为3．0～8．0cm，平均4．8cm；其中椎管内部分最大径为1．3～3．8cm，平均2．1cm。Asazuma分型ⅡC型9例，Ⅲb型2例，Ⅳ型2例，Ⅵ型1例；累及颈部节段C1-C2的1例，C2-C3的1例，C3-C4的2例，C4-C5的2例，C5～C6的3例，C6-C7的4例，C2-C4的1例。全部患者选择颈侧入路切除肿瘤，头颈外科经前、中斜角肌之间的间隙向内分离，显露横突及椎间孔定位，分块切除椎间孔外部肿瘤；神经外科于横突后方咬除上、下关节突骨质，扩大椎间孔，并经椎间孔内切开硬脊模，切除椎管内肿瘤。神经外科完成硬脊膜修补后，头颈外科再缝合关闭颈部切口。结果术后病理证实3例神经纤维瘤，11例神经鞘瘤。12例患者肿瘤全切除，2例次全切除；平均手术失血量292ml，平均手术时间129min，术后平均住院7．1d。有2例术中需显露椎动脉，无椎动脉损伤发生；3例切断载瘤神经根。术后均无脑脊液漏、局部血肿、新发的臂丛神经损伤、交感神经损伤、气管水肿等并发症发生。随访3—24个月，平均随访13．5个月；2例次全切除患者肿瘤未有增长，12例全切除患者均未复发。结论颈侧入路损伤小，简单易行，术后恢复快；由头颈外科及神经外科医师合作，可适用于治疗Asazuma分型中为ⅡC、Ⅲb或Ⅳ型，肿瘤在椎管内部分未过中线，肿瘤椎管外扩展至颈深筋膜深层的神经源性肿瘤。Objective To study the indication and character of the lateral-cervical approach for treating dumble-shape neurogenic tumors in cervical spine. Methods Retrospectively review the clinical data of 14 durable-shape neurogenic tumors in cervical spine, from October 2005 to October 2011. Among them 8 were males and 6 were females, range from 11 to 60 years old. The maximum tumor diameter range from 3.0 to 8. 0 cm, with an average of 4. 8 cm ; the intraspinal tumor diameter range from 1.3 to 3.8 cm, with an average of 2. 1 cm. According to Asazuma classification, 9 cases were type IIC, 2 cases were type rob, 2 cases were type IV, 1 case was type VI. Involving the neck segment C1-C2 in 1 case, C2-C3 in 1 case, C3-C4 in 2 cases, C4-C5 in 2 cases, C5-C6 in 3 cases, C6-C7 in 4 cases and C2-C4 in 1 case. All cases performed surgery with general anethesia. The head and neck surgeon performed surgery with lateral cervical approach, in the space between the anterior and the medius scalenus, exposed the transverse process and the intervertebral foramen as the anatomy marker, resected the extraspinal tumor part. The neurosurgery expanded the intervertebral foramen, and resected the intraspinal tumor with microscope, and repaired the dura. Then head and neck surgeon closed the wounds. Results Pathology proved 3 neurolimmoas and 11 Schwannomas, 12 cases received gross total resection, 2 cases received subtotal resection, the average blood loss during operation was 292 ml, the average operation time was 129 minutes, the average stay in hospital days was 7.1 days. The vertebral artery were exposed in 2 cases, and no vertebral artery injury occurred, there were 3 cases dissect the cervical nerve roots. No cerebrospinal fluidleakage, hematoma, newly branchial plexus injury, sympathic nerve injury or tracheal edema occured. In 3 to 24 months, with an average of 13.5 months follow-up period, 2 cases with subtotal resection had no tumor progression, and 12 cases with gross total resection had no tumor recurrence. Conclusions Lateral-cer

关 键 词：肿瘤 神经组织 神经外科手术 椎管 

分 类 号：R738.1[医药卫生—肿瘤]