半椎板入路微创治疗椎管内肿瘤  

Microsurgical treatment of intraspinal tumor by hemilaminectomy approach

作　　者：肖瑾[1] 程宏伟[1] 张义泉[1] 王先祥[1] 王斌[1] 李志范[1] 王卫红[1] 王晓健[1] 罗靖[1] 程宝春[1] 冯春国[1] 徐培坤[1] 张晓东[1] 何昊沅 

机构地区：[1]安徽医科大学第一附属医院神经外科,合肥230022

出　　处：《中国微侵袭神经外科杂志》2014年第10期451-453,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：安徽省卫生厅重点项目(编号:2010B016)

摘　　要：目的探讨半椎板入路手术治疗椎管内肿瘤的可行性及效果。方法回顾性分析106例经半椎板入路微创手术治疗椎管内肿瘤的临床资料。半侧椎板开窗从1个节段到9个节段不等。开窗大小约10～15cm：其中行神经电生理监护20例。结果肿瘤全切除98例，近全切除5例，大部分切除3例。除1例髓内肿瘤病人术后神经功能较术前稍差，其余病人神经功能障碍均不同程度改善。术后随访3～34个月，行颈、胸、腰椎MRI及x-线或CT复查，脊柱稳定性完好，脊膜瘤术后复发1例。结论半椎板入路手术创伤小，对脊柱稳定性影响小，术后恢复快，适合于椎管内大部分肿瘤的切除，术中辅以高速磨钻、神经电生理监护及超声技术，可提高对脊髓、神经功能的保护，降低手术风险及并发症。Objective To explore the feasibility and effectiveness of microsurgical treatment of intraspinal tumor by hemilaminectomy approach. Methods The clinical data of 106 patients with intraspinal tumors were analyzed retrospectively. Microsurgery via hemilaminectomy approach was performed in all the patients. The bone window for hemilaminectomy was 10-15 cm in size and differed from 1 segment to 9 segments. The neurophysiological monitoring was performed in 20 patients. Results Total resection was achieved in 98 patients, near-total in 5, sub-total in 3. All the symptoms were improved but one with intrameduUary tumor whose neurological function deteriorated after operation. There was no spinal deformity by X-ray, CT or MRI reexaminations. Recurrence was found in 1 patient with spinal meningiomas during follow-up of 3 to 34 months. Conclusions Hemilamincctomy approach can be applied to resect quite a lot of intraspinal tumors because of its minor effect on the stability of spine with minimal invasion and quick recovery. Meanwhile, the application of a high-speed drill, intraoperative electrophysiological monitoring and intraoperative ultrasound can improve the protection of spinal neurological function and decrease the risk of operation and complications after operation.

关 键 词：椎管内肿瘤 半椎板入路 神经外科手术 

分 类 号：R739.42[医药卫生—肿瘤]