椎管内髓外肿瘤19例误漏诊分析  

Intraspinal Extramedullary Tumor: Misdiagnosis Analysis of 19 Cases

作　　者：白虎虎 李宝宏 叶红勋 朱金银 

机构地区：[1]解放军18医院外二科,新疆维吾尔自治区叶城844900

出　　处：《临床误诊误治》2015年第3期38-39,共2页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨椎管内髓外肿瘤误漏诊的原因。方法分析我院2000年1月—2012年12月收治并误漏诊的19例椎管内髓外肿瘤的临床资料。结果本组早期多表现为根性痛,疼痛位于腰骶部13例,下肢7例,颈肩臂3例,胸腹部1例,部分伴肢体麻木、感觉减退、肌力减退及病理反射阳性。本组误诊14例,漏诊5例。误诊为肌肉劳损5例,腰椎间盘突出症4例,颈椎病3例,腰椎管狭窄2例。5例漏诊者因合并疾病行腰椎间盘摘除术或椎管减压术,4例术中发现椎管内髓外肿瘤,另1例术中漏诊,复诊时行MR检查确诊。14例按误诊疾病治疗效果不佳,行MR检查确诊。本组均行肿瘤摘除术并经病理证实诊断,术后恢复良好。结论椎管内髓外肿瘤早期临床表现不典型,易误漏诊。重视病史采集、仔细查体、及早行MR等影像学检查是减少误漏诊的关键。Objective To evaluate the cause of misdiagnosis and missed diagnosis in patients with intraspinal extramedul-lary tumors. Methods Clinical data of 19 patients with intraspinal extramedullary tumors, admitted to our hospital and misdiag-nosed or missed diagnosis during January 2000 to December 2012, were analyzed. Results The early clinical manifestation was Ra-dicular pain in these patients. The pain was located in lumbosacral portion in 13 patients, 7 patients in lower limbs, 3 patients in neck, shoulder and arm, 1 patient in the chest and abdomen. Some patients had limb numbness, hypoesthesia, and positive patho-logic reflex. Of all of the 19 patients, 14 were misdiagnosed, 5 missed diagnosis. Of the 14 misdiagnosed patients, 5 were misdiag-nosed as muscular strain, 4 as lumbar disc herniation, 3 as cervical spondylosis, and 2 as lumbar spinal canal stenosis. 5 missed di-agnosis patients underwent lumbar discectomy or spinal canal decompression due to complications, and intraspinal extrameduallary tumors were found in 4 cases and 1 missed diagnosis case was later confirmed by MRI. 14 cases of Misdiagnosis had poor treatment effect, MRI examination confirmed the disease in the follow-up. All the patients underwent tumor resection, and the diagnosis was confirmed by pathological diagnosis. Postoperative recovery was good. Conclusion Clinical manifestations of intraspinal extramed-ullary tumor are atypical and tends to be his diagnosed or missed diagnosis. History collection, physical examinations and MR ima-ging are essential in reducing rates of misdiagnosis and missed diagnosis.

关 键 词：脊椎肿瘤 误诊 漏诊 椎间盘移位 颈椎病 

分 类 号：R739.42[医药卫生—肿瘤]