脊椎管内神经鞘瘤27例手术治疗体会  

Experience in Surgical Treatment of 27 Patients with Intraspinal Neurilemmoma

作　　者：李海波[1] 翁益平[1] 农鲁明[1] 周栋[1] 张云坤[1] 徐南伟[1] 许长鹏[2] LI Haibo WENG Yiping NONG Luming ZHOU Dong ZHANG Yunkun XU Nanwei XU Changpeng(The Second Affiliated People＇s Hospital of Changzhou of Nanjing Medical University, Changzhou 213000, Jiangsu, China NO. 2 People＇ s Hospital of Guangdong Province, Guangzhou 510317, Guangdong, China)

机构地区：[1]南京医科大学附属常州市第二人民医院,江苏常州213000 [2]广东省第二人民医院,广东广州510317

出　　处：《山西职工医学院学报》2016年第5期4-7,共4页Journal of Shanxi Medical College for Continuing Education

基　　金：国家自然科学基金项目(81501902)

摘　　要：目的：探讨后入路椎板切除手术治疗脊椎管内神经鞘瘤的临床疗效。方法：选取南京医科大学附属常州市第二人民医院2010年1月~2015年10月收治的27例脊椎管内神经鞘瘤患者,均行后路椎板切除入路手术治疗,其中神经根与肿瘤无法分离而一并切除者5例;17例行全椎板切除或半椎板联合患侧关节突切除者采用脊柱动态椎弓根螺钉固定或椎板回植或植骨融合内固定术。术后定期随访,观察临床疗效,复查X线片观察脊柱稳定性及植骨融合情况,根据个体情况复查MRI观察肿瘤有无复发。结果：手术时间2.5~8 h,平均4.2 h;术中出血量420~1500 m L,平均760 m L。26例患者肿瘤获完全切除,1例因瘤组织侵犯前方骶血管丛行部分切除。所有病例术后病理证实为神经鞘瘤。术后10例患者出现不同程度脑脊液漏。术后随访6~75个月,全部患者临床症状及神经功能均有显著改善,1例见肿瘤残留,无病例复发。采用脊柱内固定的病例随访期间所有病例内固定稳定,未见椎体失稳。结论：后入路椎板切除手术治疗椎管内神经鞘瘤临床疗效满意;对脊柱稳定性破坏较多者术中需使用内固定重建脊柱稳定性。Objective： To investigate the clinical outcomes of posterior laminectomy surgery in the treatment of in- traspinal neurilemmoma. Methods ： A total of 27 cases with intraspinal neurilemmoma from January 2010 to October 2015 were reviewed retrospectively. All patients were treated with posterior laminectomy approach for surgical treatment. 5 cases whose nerve roots could not be separated from the tumor were removed both. 17 patients with total or semi verte- bral lamina combined with lateral facet joint resection were performed with spinal dynamic pedicle screw fixation or lami- na replantation or bone graft fusion and internal fixation. The patients were followed up regularly. The clinical outcome, the spine stability as well as recurrence were reviewed by X - ray or MRI. Results： The operation time was 2.5 - 8 hours, with an average of 4.2 hours, and blood loss was 420 -1500ml, with an average of 760ml. The tumor was com- pletely resected in 26 cases, and partially in 1 cases due to the invasion of the anterior sacral vessel. After the opera- tion, all cases were confirmed by pathological examination for schwannoma. Postoperative cerebrospinal fluid leakage oc- curred in 10 patients. Patients were followed up for 6 - 75 months. During the follow - up period, the clinical symptoms and neurological function of all patients were significantly improved, in which 1 cases had residual tumor, and no recur- rence was found. There was no spondylolisthesis or instability in all cases. Conclusions： The clinical outcomes of poste- rior laminectomy surgery in the treatment of intraspinal neurilemmoma are satisfactory, and spinal internal fixation is needed if the spinal stability gets destructed.

关 键 词：椎管内神经鞘瘤 后路手术 椎板切除 临床疗效 

分 类 号：R651.2[医药卫生—外科学]