神经内镜治疗椎管内占位性病变12例  

Applications of Neuroendoscopy for Intraspinal Space Occupying Lesions:Report of 12 Cases

作　　者：刘彬[1] 王振宇[1] 马长城[1] 林国中[1] 于涛[1] 

机构地区：[1]北京大学第三医院神经外科,北京100083

出　　处：《中国微创外科杂志》2017年第6期542-545,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北京大学第三医院2014年院重点项目基金(项目编号:bysy201304)

摘　　要：目的探讨神经内镜在椎管内占位性病变中的应用。方法 2015年1月~2016年3月对椎管内占位性病变12例,全麻下行显微镜下后正中入路选择性椎板切除或半椎板切除,导入神经内镜,在神经内镜下多角度探查切除椎管内占位性病变。结果手术时间109~316 min,中位数136 min;术中出血量50~200 ml,中位数50 ml。12例椎管内占位内镜下病变全切,症状缓解。术后病理:神经鞘瘤6例,软骨样组织4例,畸胎瘤2例。术后JOA评分中位数28.5分(17~29分),显著高于术前中位数21.5分(5~27分)(Z=-2.936,P=0.003);治愈7例,显效5例。12例随访11~24个月,平均16.5月,未见肿瘤和间盘突出复发及脊柱不稳事件发生,无术后感染及新增神经损伤症状。结论神经内镜可以近距离多角度观察、定位椎管内病变,避免术中操作的盲目性,直视下进行操作对于病变的切除有指导意义,与显微镜联合应用可降低患者损伤。Objective To investigate the applications of neuroendoscopy for intraspinal space occupying lesions. Methods A total of 12 patients who suffered from occupying lesions within spinal canal admitted into our department from January 2015 to March 2016 were treated with neuroendoseopy. Selective laminectomy or hemi-laminectomy was performed through posterior midline approach with microscope under general anesthesia. By using neuroendoscopy, occupying lesions within spinal canal were removed. All the cases were probed in different visual angles. Results The operation time was 109 -316 min （median, 136 min） and the intraoperative blood loss was 50 - 200 ml （ median, 50 ml ）. All the patients were fully recovered, without infection or neurologic symptoms. Occupying lesions within spinal canal were removed totally under ueuroendoscope. The pathological examinations showed neurinoma in 6 cases, ehondroid tissue in 4 cases and teratic tumor in 2 cases. Symptoms were relieved in all cases postoperatively. The postoperative JOA score was 17 -29 points （median, 28.5 points） , which was significantly higher than the preoperative level [5 -27 points （ median, 21.5 points） , Z = - 2. 936, P = 0. 003 ]. There were 7 cases of cure and 5 cases of markedly effective. The 12 cases were followed up for 11- 24 months （mean, 16. 5 months）. No recurrence of tumor or intervertebral disc herniation or spinal instability occurred. Conclusion Neuroendoscopy is helpful for surgeons to localize and remove lesions directly in short distance and different visual angles, avoiding blind manipulation and injury while combined with microscopy.

关 键 词：神经内镜 脊髓外科 脊髓肿瘤 

分 类 号：R739.4[医药卫生—肿瘤]