骶管蛛网膜囊肿的显微手术效果及影响因素  

Effect of microsurgery on sacral canal arachnoid cysts and its influential factors

作　　者：李百升[1] 罗洪海[1] 祝刚[1] 晏广[1] 李志平[1] 黄小山[1] 

机构地区：[1]广东惠州市中心人民医院神经外科,惠州516001

出　　处：《河南外科学杂志》2016年第3期1-3,共3页Henan Journal of Surgery

摘　　要：目的探讨显微外科手术治疗骶管蛛网膜囊肿的效果及其影响因素。方法回顾性分析对12例症状性骶管蛛网膜囊肿患者实施手术治疗的临床资料,总结术中病理改变、手术策略及其效果等。结果术中发现合并脊柱裂3例,包括棘突缺如1例,椎板部分缺如2例,马尾粘连5例,蛛网膜异常粘带形成4例,硬脊膜粘连形成1例,硬脊膜憩室形成并马尾嵌顿1例。术后臀部及腰骶部疼痛消失7例(7/10),部分缓解3例,膀胱直肠功能障碍消失4例(4/5),好转1例,肢体乏力恢复正常3例(3/3),无手术切口愈合不良及脑脊液瘘病例。结论显微手术治疗症状性骶管蛛网膜囊肿疗效肯定,尤其对肢体乏力及膀胱直肠功能障碍患者有较高缓解率,对神经根痛亦有较好缓解效果。术中蛛网膜囊肿远近端充分开窗、充分松解马尾粘连、消除硬脊膜憩室、修补脊柱裂以及重视术后手术切口皮肤管理是保证手术效果的重要举措。Objective To investigate the effect of microsurgery on patients with sacral canal arachnoid cysts and its influential factors.Methods Retrospectively analyzing the clinical data of 12 patients with symptomatic sacral canal arachnoid cysts and implemented operation treatment in Department of Neurosurgery Huizhou Central People＇s Hospital from January 2009 to November 2014. The pathological changes,operation strategy and its effect was summarized intra and postoperative. Results During the operation,among those patients,there were 3 cases with spina bifida,including spinous process congenital absence in 1 case,partial congenital absence of lamina of vertebra in 2 cases. 5 cases with cauda equina adhesion were found too,including arachnoid abnormal adhesive band formed in 4 cases and dural adhesion formation in1 case. 1 case was found with dural diverticulum formed and cauda equina incarceration. As to the treatment effectiveness,7 cases of hip and lumbosacral pain disappeared after operation（ 7 /10）,partial remission in 3 cases,bladder and bowel dysfunction disappeared in 4 cases（ 4 /5）,1 case improved,weakness of limbs recovered to normal in 3 cases（ 3 /3）. No bad wound healing and cerebrospinal fluid fistula case was found. Conclusion There was a good effect of microsurgery for patients with symptomatic sacral canal arachnoid cyst,especially with high response rates of limb weakness,bladder and bowel dysfunction and also the effect of relieving better on nerve root pain. The proximal and distal fenestration of arachnoid cyst,sufficient loosing adhesions of cauda equina,eliminate the dural diverticulum together with repair of spina bifida were very important to ensure the effect of operation during operation and also the skin incision should pay attention after the operation.

关 键 词：骶管蛛网膜囊肿 显微手术 病理 疗效 影响因素 

分 类 号：R681.57[医药卫生—骨科学]