颈髓髓内肿瘤的手术治疗及预后因素分析  

Surgical treatment and prognostic factors of cervical intramedullary spinal cord tumors

作　　者：陈峰[1] 陈佩钦[1] 钱俊[1] 卢亦成[1] 丁学华[1] 胡国汉[1] 骆纯[1] 

机构地区：[1]第二军医大学长征医院神经外科,上海200003

出　　处：《第二军医大学学报》2015年第12期1304-1308,共5页Academic Journal of Second Military Medical University

摘　　要：目的探讨颈髓髓内肿瘤手术治疗及患者术后神经功能状况的预后因素。方法回顾性分析2009年1月至2013年12月接受手术治疗的65例颈髓髓内肿瘤患者资料。应用McCormick分级系统评估患者手术前后神经功能状态,并采用多因素logistic回归法分析术后神经功能状况的预后因素。结果术中采用全椎板切除暴露61例,单侧多节段椎板间开窗4例。肿瘤全切48例,次全切除4例,部分切除13例。随访4个月至15年,中位随访时间为68个月。术后临床症状好转42例,维持术前14例,加重9例。其中疼痛缓解率最高（82.4%,28/34）,其次为括约肌功能障碍缓解率（68.8%,11/16）,感觉障碍缓解率最低（39.6%,21/53）。根据McCormick评分标准,术后神经功能好转18例（27.7%）,维持术前水平39例（60.0%）,8例（12.3%）患者神经功能恶化。多因素logistic回归分析提示良好的术前神经功能状态（OR=20.381,95%CI：4.918-84.460,P=0.000）和手术全切（OR=6.338,95%CI：1.242-32.335,P=0.026）是术后神经功能状况的保护因素。结论显微手术切除是颈髓髓内肿瘤的首选治疗方式,术后患者大都预后良好。术前神经功能状态及手术切除范围与患者神经功能预后相关。Objective To summarize our experience in surgical treatment of cervical intramedullary spinal cord tumors and to identify the prognostic factors associated with postoperative neurological status.Methods The clinical data of 65 consecutive patients with cervical intramedullary spinal cord tumors undergoing operation between Jan.2009 and Dec.2013 were retrospectively reviewed.McCormick Scale was applied to evaluate the preoperative and postoperative neurological functions.Multivariate logistic regression analysis was used to determine the independent prognostic factors of postoperative neurological status.Results Laminectomy was performed in 61 patients and unilateral multilevel interlaminar fenestration（UMIF）was applied in 4patients.Of all the 65 patients,48received total resection,4received subtotal resection and 13 received partial resection.The follow-up time was from 4 months to 15 years.The median follow-up time was 68 months.The clinical symptoms were relieved in 42 patients after operation,maintained unchanged in 14 and aggravated in 9.The pain remission rate of the patients was the highest（82.4%）,followed by the sphincter dysfunction remission rate（68.8%）,and the sensory disturbance remission rate of the patients was the lowest（39.6%）.Based on McCormick Scale,the postoperative neurological functions was improved in 18patients（27.7%）and maintained unchanged in 39（60%）,while eight patients（12.3%）developed neurological deterioration. Multivariate logistic regression analysis revealed that good preoperative neurological function（OR=19.87,95% CI：4.10-96.23,P=0.000）and total resection（OR=7.40,95% CI：1.34-40.95,P=0.022）were the independent protective factors for postoperative neurological status.Conclusion Microsurgical resection is the firstline treatment for cervical intramedullary spinal cord tumors,which can achieve a satisfying outcome in most cases.Preoperative neurological status and surgical extent are significantly associated with the postoperative functional outco

关 键 词：脊髓肿瘤 显微外科手术 神经功能 预后 

分 类 号：R739.42[医药卫生—肿瘤]