脊髓髓内室管膜瘤的诊断及手术治疗  

The diagnosis and the surgical treatment of the spinal intramedullary ependymoma

作　　者：李书忠[1] 胡有谷[1] 刘吉华[2] 李玉军[3] 

机构地区：[1]青岛大学医学院附属医院骨科,266003 [2]青岛大学医学院附属医院放射科,266003 [3]青岛大学医学院附属医院病理科,266003

出　　处：《中华骨科杂志》2002年第1期11-13,共3页Chinese Journal of Orthopaedics

摘　　要：目的探讨脊髓髓内室管膜瘤的诊断、手术要点及注意事项。方法回顾分析经手术及病理证实的16例髓内室管膜瘤临床资料。男9例,女7例;年龄21～60岁,平均33.5岁。首发症状主要为受累肢体麻木无力和(或)感觉异常,随病程由上向下发展为其特征。13例行MR检查,示髓内占位性病变。完全切除11例,大部切除3例,减压活检2例。结果12例得以随诊,时间为8个月～5年8个月,症状明显改善7例,其中脊髓功能评分提高11～20分4例,10分以下3例;症状稳定3例;术后症状缓解再加重2例。结论特有临床表现及影像学所见为诊断主要依据,因其在髓内膨胀生长,多与脊髓界限清楚,掌握手术要点即可完全切除,诊断一旦确立,根据MRI所见,应尽早手术。术中探查其与脊髓界限是否清楚为手术关键。Objective To evaluate the diagnosis and the operative procedure of the spinal intramedullary ependymoma. Methods 16 cases of spinal ependymoma confirmed operatively and pathologically were reviewed. 9 male and 7 female with average age of 33.5 years were included in this study. The primary symptoms were mainly numbness, weakness and paresthesia of extremities with the characteristics of progressing from upwards to downwards. 13 cases were MR-scanned, showing intramedullary space occupying lesions. Its complete surgical removal was achieved in 11 patients, partial removal in 3, decompression and biopsy in 2. Results Twelve patients were followed up from 8 to 68 months. Symptoms in 7 patients were obviously improved. Spinal function scores were increased by 11 to 20 in 4 cases, less than 10 in 3. Symptoms were stable in 3 cases, worsened again after postoperative relief in 2. Conclusion The specific clinical and radiological findings are the principal evidence for the diagnosis of the intramedullary ependymoma. Since the growth of the tumor is through intramedullary extension, it usually has a clear boundary in the spinal cord. The lesion could be completely removed with experienced surgical technique. When the diagnosis is established, early surgery is recommended. The key point of successful removal is to explore a clear demarkation between the tumor and the spinal cord.

关 键 词：脊髓髓内室管膜瘤 诊断 手术治疗 膨胀性生长 影像学检查 

分 类 号：R738[医药卫生—肿瘤]