显微外科手术切除脊髓髓内肿瘤的疗效  

Microsurgical resection of intramedullary spinal cord tumors： clinical efficacy and the medium-and long-term follow-up outcomes

作　　者：刘通[1] 刘辉[1] 张建宁[1] 朱涛[1] 

机构地区：[1]天津医科大学总医院神经外科,300052

出　　处：《中华神经外科杂志》2015年第6期578-582,共5页Chinese Journal of Neurosurgery

摘　　要：目的 探讨不同病理类型髓内肿瘤的手术策略及临床预后.方法 回顾性分析2000年6月至2013年8月天津医科大学总医院神经外科在神经电生理辅助下经显微手术切除的178例髓内肿瘤患者的临床资料.采用Klekamp-Samii （KS）评分法评估术前及术后脊髓功能;评估随访时间≥18个月、不同病理类型患者的手术切除及复发情况.结果 178例中,术后6个月症状改善者142例,无变化者28例,加重8例.除星形细胞瘤外,其他类型肿瘤术后6个月脊髓功能KS评分均较术前明显改善,差异有统计学意义（P＜0.05）.157例随访时间≥18个月（18 ～78个月）,平均（46.6±5.4）个月.157例中,全切除95例,复发1例（1.1％）,近全切除44例,复发5例（11.4％）;部分切除18例,复发17例（94.4％）.其中室管膜瘤68例,全切除68例,无复发.星形细胞瘤19例,全切除5例,复发1例;部分切除14例,全部复发.脂肪瘤19例,近全切除17例,无复发;部分切除2例,均复发.血管母细胞瘤、海绵状血管瘤、血管瘤、血管外皮瘤、肠源性囊肿共22例,全部为全切除,无复发;表皮样囊肿15例,全部为近全切除,复发3例;皮样囊肿14例,近全切除12例,复发2例;部分切除2例,复发1例.结论 显微外科手术治疗脊髓髓内肿瘤安全有效,肿瘤病理类型及切除范围是决定中远期疗效的重要原因.Objective To investigate the operation strategies and clinical prognosis of the different pathological types of intramedullary tumors.Methods The clinical data of 178 patients with intramedullary tumor whose tumors were resected by microsurgery under the neural electrophysiological assistance at the Department of Neurosurgery,Tianjin Medical University General Hospital from June 2000 to August 2013 were analyzed retrospectively.Klekamp-Samii （KS） score was used to evaluate the spinal cord function before and after procedure.The follow-up time ≥ 18 months and surgical resection and recurrence in the patients with different pathological types were evaluated.Results In 178 patients,the symptoms of 142 were improved at 6 months after procedure,28 did not have any change,and 8 aggravated.In addition astrocytoma,the KS scores of spinal cord function of other types of tumors at six months after surgery were improved significantly compared with before surgery.There was significant difference （P 〈 0.05）.The follow-up time of 157 patients were ≥ 18 months （18 to 78 months,mean 46.6＆#177;.5.4 months）.In 157 patients,95 were resected totally,1 （1.1%） had recurrence,44 were nearly resected totally,and 5 （11.4%） had recurrence; 18 were resected partially and 17 （94.4%） had recurrence.Sixty-eight of them had ependymoma and 68 were resected totally,and none of them had recurrence.Nineteen patients had astrocytoma,5 were resected totally,and one had recurrence; 14 were resected partially and all had recurrence; 19 had lipoma,17 were nearly resected totally,and none of them had recurrence; 2 were resected partially and all had recurrence.A total of 22 patients had hemangioblastoma,cavernous hemangioma,hemangioma,hemangiopericytoma,and intestinal cyst,all were resected totally,none of them had recurrence; 15 had epidermoid cyst,all were nearly resected totally,and 3 had recurrence; 14 had dermoid cyst,12 were nearly resected totally,and 2 had recurrence; 2 were resected partially and one had recurren

关 键 词：脊髓肿瘤 显微外科手术 病理学 外科 随访研究 

分 类 号：R739.42[医药卫生—肿瘤]