脊柱节细胞神经瘤的临床特点与手术治疗  

Clinical characteristics and surgical treatment of ganglioneuroma in spine

作　　者：黄勇[1] 吕振山[1] 刘理迪[1] 吴迪[1] 李乔[1] 张绍昆[1] 

机构地区：[1]吉林大学第一医院脊柱外科,吉林长春130021

出　　处：《中国骨伤》2015年第11期1013-1016,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的 :总结脊柱节细胞神经瘤的临床表现及诊断,探讨其手术治疗效果。方法 :对2008年1月至2015年1月行手术治疗的6例脊柱节细胞神经瘤患者进行回顾性分析,男4例,女2例;年龄2~63岁,平均34.6岁;病程3 d^17年。5例患者有与肿瘤所在水平相关的浅感觉减退,肿瘤平面以下不同程度的肌力减退(肌力Ⅱ-Ⅳ级);2例肌张力增高,双侧Hoffmann征、Babinski征阳性;5例为相应节段椎管内单发病灶,1例合并胸腔内巨大占位性病变。结果:6例患者中5例肿瘤全切除,1例行次全切除。术后病理检查可见肿瘤性节细胞散在或成束穿插于Schwann细胞间质中。术前2例神经根痛患者,术后1例症状缓解或消失,1例无变化。术前4例上下肢运动障碍者,术后均改善。随访时间0.3~6.8年,平均2.5年。末次随访时脊髓功能状态按ASIA分级标准评价,5例好转,1例不变。1例次全切除患者因合并节细胞神经母细胞瘤,术后行放化疗,另5例无复发。结论:脊柱节细胞神经瘤较罕见,肿瘤本身为良性,临床上以根性疼痛及感觉运动障碍为主要表现;其诊断主要依靠术后病理检查确诊。手术全切除后预后良好。Objective：To summarize the clinical manifestation and diagnosis of ganglioneuroma in spine and investigate the clinical effect of surgical treatment. Methods：The clinical data of 6 patients underwent a surgery for ganglioneuroma in spine from January 2008 to January 2015 were retrospectively analyzed. There were 4 males and 2 females,aged from 2 to 63 years old with an average of 34.6 years. The courses of disease were from 3 days to 17 years. Five patients complicated with superficial hypesthesia in correlative level of tumor,and the muscle strength under tumor plane had decreased at different levels,with the strength of grade Ⅱ- Ⅳ. Two cases complicated with hypermyotonia and positive bilateral Hoffmann ＇s and Babinski sign. Five cases were sporadic lesion in correlative spinal canal and one case complicated with the giant occupying lesion in thoracic cavity. Results：Six operations had been performed including 5 en bloc and l subtotal resection. Postoperative pathological results showed tumor cells scattered or fasciculated inserted into Schwann cells in the stroma. In 2 patients complicated with radiculalgia before operation,1 case was relieved and 1 was invariant after operation. All 4 patients with preoperative dyscinesia in the limbs obtained improvement after operation. All the patients were followed up from 0.3 to 6.8 years with an average of 2.5 years. At the final follow up,according to ASIA grade,5 cases were good and 1 case was invariant. During the follow up,only 1 patient experienced chemoradiation because of merging ganglioneuroblastoma and receiving subtotal resection. No recurrence in other 5 cases. Conclusion：Ganglioneuroma is a benign and rare tumors in spine. Clinically,radicular pain and sensory motor disorders are the main manifestations. Its diagnosis depends on pathological examination. Prognosis of surgical treatment is good.

关 键 词：神经节瘤 肿瘤 脊柱 外科手术 

分 类 号：R736.6[医药卫生—肿瘤]