经骶后正中入路手术治疗先天性骶前脊膜膨出  

Median posterior sacral approach for treatment of congenital anterior sacral meningocele

作　　者：鲁润春[1] 赵晓文[1] 伊志强[1] 张彦芳[1] 

机构地区：[1]北京大学第一医院神经外科,100034

出　　处：《中华神经外科杂志》2017年第2期133-137,共5页Chinese Journal of Neurosurgery

摘　　要：目的 探讨先天性骶前脊膜膨出的临床特征和手术治疗方法.方法 回顾性分析201 1年4月至2015年10月北京大学第一医院神经外科收治的4例先天性骶前脊膜膨出患者的临床资料.患者的年龄为13 ～ 49岁,其中男2例,女2例.1例合并脊髓拴系,1例合并双角子宫,1例合并表皮样囊肿,1例合并Currarino综合征.临床表现为腹部包块、下腹部疼痛以及大小便障碍.4例均采用骶后正中入路行手术治疗,1例术中采用神经内镜辅助.随访时间为6 ～55个月.结果 术后所有患者的临床症状均明显改善,复查MRI提示膨出部分显著缩小.结论 先天性骶前脊膜膨出较为罕见,临床表现主要为盆腔压迫症状.经骶后正中入路手术是治疗先天性骶前脊膜膨出安全、有效的方法.利用神经内镜可清晰地观察神经结构,有助于保护神经并确定瘘口.Objective To explore the clinical characteristics and surgical treatment of anterior sacral meningocele （ASM）.Methods A retrospective analysis was conducted for 4 patients with ASM who were admitted to Department of Neurosurgery,Peking University First Hospital from April 2011 to October 2015.The patients included 2 men and 2 women and their ages ranged from 13 to 49 years old.One patient had the comorbidity of tethered cord syndrome,one had uterus bicornis,one had epidermoid cyst,and one had Currarino syndrome.Their main symptoms included lower abdominal mass,pain,constipation and urinary dysfunction.All cases received surgical treatment through median posterior sacral approach.Neuroendosope was applied for assistance in one case.The follow-up lasted for 6 ～ 55 months.Results All patients received significant symptom improvement postoperatively,and the ASM collapsed remarkably based on MRI examination.Conclusions The clinical manifestations of ASM,chnical uncommon,mainly include symptoms due to pelvic organ compression.Surgical operations through median posterior sacral approach seem to be safe and effective for treatment of ASM.Neuroendosope could be useful in observation and protection of the neural structures.

关 键 词：神经管缺损 脊髓脊膜膨出 显微外科手术 

分 类 号：R651.2[医药卫生—外科学]