脊髓神经鞘瘤微创小椎板切除术45例分析  

Analysis of 45 Cases of Spinal Schwannomas Minimally Invasive Operation

作　　者：毛仁玲[1] 张法永[1] 高幸[1] 陈宏[2] 江澄川[1] 

机构地区：[1]复旦大学附属华山医院神经外科,200040 [2]复旦大学附属华山医院神经病理室,200040

出　　处：《中国临床神经科学》2015年第1期46-50,共5页Chinese Journal of Clinical Neurosciences

摘　　要：目的探讨微创小椎板切除技术在脊髓神经鞘瘤手术中应用的意义。方法回顾性分析45例接受微创小椎板切除法治疗脊髓神经鞘瘤患者的临床资料。结果肿瘤位于硬膜下髓外32例,硬膜下硬膜外哑铃状肿瘤6例,硬膜外鞘袖型5例,髓内肿瘤2例。肿瘤最大径2～9 cn。手术应用微创小椎板切除法在显微镜下行肿瘤切除,45例均达全切除。住院期间32例症状好转,13例稳定。出院后随访时间5～40个月,获随访43例,好转38例,稳定5例;无手术区肿瘤复发、病情加重,无脊柱稳定性相关并发症,未见脊柱变形。结论微创小椎板切除入路手术切除脊髓神经鞘瘤安全、创伤小,术后不需脊柱稳定性加固,较常规手术操作难度无明显增大;但在较大体积的髓内型脊髓神经鞘瘤慎用。Aim To explore the significance of minimally invasive small laminectomy technology for application in spinal schwannoma operation.Methods A retrospective analysis was undertaken for the clinical data of 45 cases of schwannoma of spinal cord with the minimally invasive operation.Results Tumors of 32 cases were located in the subdural,subdural and epidural dumbbell shaped tumors in 6 cases,epidural tumors in 5 cases,intramedullary spinal cord tumors in 2 cases.The largest tumor length was 2-9 cm.The minimally invasive small laminectomy technology were used in operations of tumor resection with microscope,the tumor total excisions were in all 45 cases.The symptoms improved in 32 cases during hospitalization,13 cases were stable.43 cases were followed up for 5 to 40 months.38 cases improved,5 cases were stable.There were no tumor recurrence in operation region,no exacerbation,no spinal stability related complications,no distortion of the spine.Conclusion The operations of resection of spinal cord schwannomas with minimally invasive small laminectomy approach are a safe small trauma without spinal stability reinforcement post operation,no more difficult than conventional laminectomy technology.But it should be treated with caution in the large schwannoma of spinal cord intramedullary.

关 键 词：脊髓神经鞘瘤 微创 显微手术 半椎板切除 小半椎板切除 

分 类 号：R730.264[医药卫生—肿瘤] R739.42[医药卫生—临床医学]