脊膜瘤手术中切除硬脊膜内层的临床疗效分析  

Analysis of the clinical effect of inner dural resection in spinal meningioma surgery

作　　者：徐宝占 初明[1] 卫永旭[1] 靳世辉[1] 庞博[1] 杨钟会 王殿洪[1] 李国忠[1] 

机构地区：[1]哈尔滨医科大学附属第一医院神经外科,150001

出　　处：《中华神经外科杂志》2015年第11期1141-1145,共5页Chinese Journal of Neurosurgery

基　　金：黑龙江省教育厅课题（12531228）

摘　　要：目的探讨脊膜瘤手术中切除硬脊膜内层的临床疗效。方法回顾性分析2007年1月至2013年11月于哈尔滨医科大学附属第一医院神经外科确诊为脊膜瘤并行硬脊膜内层切除术的25例患者，所有肿瘤均位于髓外硬膜下，对所有病例行组织病理学检查，以判断脊膜瘤对蒂部硬脊膜内层的侵袭性，分析该技术的可行性并统计患者出现脑脊液漏等并发症的发生率和肿瘤的复发率。结果本组25例患者的肿瘤均完全切除，肿瘤组织病理检查证实均为WHOI级脊膜瘤，其中砂粒体型13例，脑膜上皮型10例，过渡型1例，血管瘤型1例。所有患者硬脊膜HE染色病理检查显示肿瘤均未侵袭到瘤蒂部硬脊膜内层。术后均无脑脊液漏及脊髓粘连等手术相关并发症。25例患者平均随访31．2个月，MRI检查均未见肿瘤复发。术前有神经功能缺失症状的患者在术后均有不同程度的改善。结论硬脊膜内层切除术治疗脊膜瘤手术效果良好，在减少肿瘤残余、降低术后肿瘤复发率的同时，也可减少脑脊液漏、脊髓粘连等术后并发症的发生。但是本研究的病例数量较少，随访的时间尚短，且为回顾性研究，对于此术式的效果仍需长时间的随访。Objective To investigate the clinical efficacy of the inner dual layer resection for the treatment of spinal meningiomas. Methods Twenty-five patients who were diagnosed as spinal meningioma and underwent the inner dual layer resection at the Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University from January 2007 to November 2013 were analyzed retrospectively. All the tumors were located in subdural extramedullary space. All patents underwent histopathological examination in order to identify the invasiveness of meningioma to inner dural layer of the pedicle. The feasibility of this technique was analyzed; the incidence of complications such as cerebrospinal fluid fistulas and the tumor recurrence rate were calculated. Results The tumors of 25 patients were resected completely in this group. Tumor histopathological examination confirmed spinal meningiomas （ WHO grade 1 ）, 13 of the patients were psammomatous type, 10 were meningeal epithelial type, 1 was transitional type, and lwas angiomatous type. The dural HE staining pathological examination in all patients revealed that the inner dual layers in tumor pedieles were free of tumor penetration. The patients did not have any surgery-related complications, such as cerebrospinal fluid fistula and spinal adhesion. The 25 patients were followed up for a mean of 31.2 months. MRI did not find tumor recurrence. The patients with neurological deficits before procedure were improved in varying degrees after procedure. Conclusions The operation effect of inner dual layer resection in the treatment of spinal meningiomas is good. It can not only reduce the residual tumor and tumor recurrence, but also decrease cerebrospinal fluid fistula, spinal adhesions, and other postoperative complications. However, the number of cases of the study is small, the follow-up time is short, and it is a retrospective study, therefore, the effect of operation needs to be followed up for a long time.

关 键 词：椎管 脊膜瘤 硬脊膜 治疗结果 复发 

分 类 号：R739.4[医药卫生—肿瘤]