显微镜与双极电凝在神经鞘膜瘤手术中的应用及效果观察  

Effects of bipolar coagulation forceps and microscope in intradural-extramedullary schwannomas surgery

作　　者：张礼平[1] 程利华[1] 刘世长[2] 朱立国[3] 刘德玉[4] 

机构地区：[1]陕西中医药大学,陕西咸阳712046 [2]西安交通大学医学院附属红会医院脊柱外科,陕西西安710054 [3]中国中医科学院望京医院,北京100102 [4]陕西中医药大学附属医院,陕西咸阳712021

出　　处：《颈腰痛杂志》2017年第2期149-152,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨显微镜联合双极电凝系统在髓外硬膜内神经鞘瘤手术中的应用及临床疗效,总结临床经验。方法 2014-01-2016-01收治的髓外硬膜内神经鞘膜瘤患者23例,男14例,女9例;年龄32~71岁,平均(45.1±3.9)岁。颈椎5例,胸椎7例,腰椎11例。所有患者均在显微镜配合双极电凝系统的辅助下手术摘除瘤体,术后修补硬脊膜,并行后路植骨融合内固定术;采用ASIA感觉、运动评分对神经症状进行评估,以及术后脑脊液的发生情况。结果术中瘤体均完全切除,术后所有病例均获得随访,随访时间6~30个月,平均(15.3±4.5)个月。患者术后神经损伤程度较轻,术后随访神经症状较术前均有明显改善;术后均出现脑脊液漏,平均(1239±352)ml,引流时间3~7 d,平均(5.2±2.2)d,拔除引流管后伤口均完全愈合,未出现明显其他的临床并发症。结论采用该手术方式治疗髓外硬膜内神经鞘膜瘤临床疗效确切,为此类手术提供参考。Objective To investigate the surgical methods of intradural-extramedullary sehwannomas （IEM） under bipolar coagulation forceps and microscope auxiliary and postoperative clinical effects, and to summarize the clinical experience. Methods Twenty-three IEM patients who were treated between January 2014 to January 2016 were enrolled in this retrospective study. There were 14 men and 9 women with an average age of （45.1±3.9） years （ranged 32-71 years）. Of all cases, there were 5 cases in cervical spine,7 cases in the thoracic,12 cases in the lumbar. The tumors were removed under bipolar coagulation forceps and microscope auxiliary in all patients, and dura was repaired after surgery, and spinal internal fixation and bone graft fusion were performed. The patients＂ neurological functions were graded according the ASIA score system, and the postoperative eerebrospinal fluid leakage（CSF） was observed. Results The complete resection was achieved and the average duration of follow-up was （15.3 ±4.5） months （ranged 6-30 months） in all patients. The postoperative neurological deficit to a lesser degree and obviously improved through follow-up. The CSF leakage was found in all cases, average drainage of （5.2±2.2） days （ranged 3-7 days） and（ 1239± 352）ml. The wounds were healed completely without any other clinical complications. Conclusion This surgical proeedures for IEM eould gain better result, the safety of operation is inereased.

关 键 词：神经鞘膜瘤 双极电凝 显微镜 手术治疗 临床疗效 

分 类 号：R739.43[医药卫生—肿瘤]