经半椎板切除入路显微操作摘除椎管内髓外硬膜下肿瘤的手术方法及效果评价  

Techniques and evaluation of microsurgical resection of intradural extramedullary tumors through hemilaminectomy

作　　者：刘加贝[1] 李忱[1] 顾锐[1] 高忠礼[1] 王金成[1] 

机构地区：[1]吉林大学中日联谊医院骨科,吉林长春130033

出　　处：《吉林大学学报（医学版）》2013年第5期991-994,I0004,共5页Journal of Jilin University：Medicine Edition

基　　金：吉林省科技厅科技发展计划项目资助课题(20110484)

摘　　要：目的:探讨经半椎板切除入路显微操作摘除椎管内髓外硬膜下肿瘤(IDEM)的手术方法,进一步阐明其临床效果。方法:回顾分析2009年1月—2011年12月本院治疗16例IDEM患者的临床资料,其中男性7例,女性9例;年龄34～72岁,平均年龄49岁。肿瘤位于颈段3例,胸段4例,胸腰段9例。14例患者行半椎板入路切除肿瘤,2例患者术中改为全椎板入路切除肿瘤。通过患者术前和术后Frankel分级评价半椎板入路的临床效果。结果:术中平均出血量为300mL(150～500mL),手术时间140min(90～200min)。肿瘤体积最大4.0cm×1.5cm×1.5cm,最小1.5cm×1.0cm×1.0cm。术后病理证实,神经鞘瘤11例,脊膜瘤4例,神经纤维瘤1例。16例患者中,术前Frankel分级B级3例,术后提高为C级;术前C级5例,术后提高为D级;术前D级7例,术后提高为E级。神经鞘瘤11例,脊膜瘤4例,神经纤维瘤1例。所有患者均得到随访(6～40个月),平均随访时间为23.7个月。16例患者均未见复发且脊柱稳定性良好。行半椎板入路及全椎板入路的平均出血量分别为275和475mL。结论:半椎板切除术治疗IDEM具有损伤较小、出血较少等优点,并且可以最大限度地维持脊柱的稳定性。经半椎板切除入路摘除IDEM的手术效果令人满意。Objective To investigate the microsurgical techniques of the excision of the intradural extramedullary tumors through hemilaminectomy and to illustrate its clinical effect.Methods The clinical data of 16patients（7men,9women）with intradural extramedullary tumors treated in our hospital from January 2009to December 2011was retrospectively analyzed.The average age was 49years,ranging from 34-72years.The intradural extramedullary tumors located at the cervical level in 3 patients,thoracic in 4 patients,thoracico-lumbar in 9patients.14 patients underwent hemilaminectomy while 2 patients were treated with laminectomy during operation.The clinical effect of hemilaminectomy was evaluated based on Frankel grade.Results The mean bleeding volume was 300mL（150-500mL）and the mean duration of operation was 140min（90-200min）.The maximum volume of the tumor was 4.0cm ×1.5cm ×1.5cm,while the minimum one was 1.5cm ×1.0cm × 1.0cm.There were neurinoma in 11patients,meningioma in 4cases and neurofibroma in 1case.3cases ameliorated from Frankel grade B to C;5cases of Frankel grade C recovered to grade D;7cases of Frankel grade D was improved to grade E.All the patients were followed up from 6to 40months with an average of 23.7months.None of the patients showed tumor recurrence and spinal instability.Conclusion The mean bleeding volumes of the patients underwent hemilaminectomy and laminectomy are 275and 475 mL,respectively.The advantages of the approach are minor invasion,less bleeding,and retaining the spinal stability.The outcome of the excision of the intradural extramedullary tumors through hemilaminectomy is satisfactory in general.

关 键 词：髓外硬膜下肿瘤 半椎板切除术 显微外科手术 Frankel分级 脊柱稳定性 

分 类 号：R739.4[医药卫生—肿瘤]