椎管内畸胎瘤的诊断与治疗  

Dignosis and treatment of intraspainal teratomas

作　　者：赵东升[1] 王正君[1] 孙刚锋[1] 费舟[1] 姬西团[1] 李娟[1] 万晓强[1] 

机构地区：[1]第四军医大学西京医院神经外科,西安710032

出　　处：《中国临床神经外科杂志》2015年第11期661-664,共4页Chinese Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(81172095)

摘　　要：目的探讨椎管内畸胎瘤的诊断与治疗方法。方法2010年3月至2014年9月收治的椎管内畸胎瘤132例，均采用显微手术治疗，其中颈椎管内3例，胸椎管内25例，腰椎管内99例，骶管内5例；术中行棘突复合体复位固定，恢复脊柱后柱解剖结构。结果本组在保留神经功能的情况下全切肿瘤10例，次全切48例，部分切除74例。术后病理示成熟型畸胎瘤92例，未成熟型27例，恶性13例。术后随访6个月-4年，成熟型复发3例，未成熟型复发2例，恶性复发5例；复发者Ki-67〉5％。未见椎管狭窄、椎体滑脱畸形等脊柱不稳定并发症。结论术前MRI对椎管内畸胎瘤有定性、定位诊断意义；棘突复合体术中回纳固定对于维持脊柱稳定性有确切疗效；Ki-67可作为肿瘤术后复发的预测指标。Objective To discuss the diagnosis and treatment of intraspainal taratomas （IST）. Methods of 132 patients with IST treated by surgery, 3 had IST at the cervical trigon of spinal cord, 25 at the thoracic segments, 99 at the lumbar segments, and 5 at the sacral canal. The reduction and internal fixation of the spines complex and recovery of structure of the posterior column of the spinal column were performed in all the patients. Results The postoperative pathological examination showed that of 132 cases of teratomas, 92 were mature teratomas, 27 immature and 13 malignant. All the patients were followed up from 6 months to 4 years. Of 10 patients who suffered from the recurrence of the teratomas during the follow up, 3 had the mature type, 2 immature and 5 malignant before the operation. The rate of Ki-67 expression in the teratomas tissues was more than 5% in the patients with recurrent teratomas. The complications including the stenosis of the spinal canal and slippage deformity of the vertebral bodies did not occur in all the patients during the following up. Conclusions MRI is sensitive method to distinguish IST from the other tumors. The spines complex reduction and fixation are very helpful to the postoperative spinal stability in the patients with IST. It is suggested that the high expression of Ki-67 in the teratomas tissues may be used as a predictor of tumorous recurrence in the patients with IST.

关 键 词：畸胎瘤 椎管内肿瘤 显微手术 疗效 

分 类 号：R739.42[医药卫生—肿瘤] R651.11[医药卫生—临床医学]