小切口半椎板开窗手术切除椎管内肿瘤  

Hemilaminectomy based on fenestration operation with small incision for intraspinal tumors

作　　者：王先祥[1] 张义泉[1] 肖瑾[1] 朱浩 张科[1] 程宏伟[1] Wang Xianxiang Zhang Yiquan Xiao Jin Zhu Hao Zhang Ke Cheng Hongwei(Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, Chin)

机构地区：[1]安徽医科大学第一附属医院神经外科,合肥230022

出　　处：《中国微侵袭神经外科杂志》2017年第9期408-410,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨小切口半椎板开窗显微手术切除椎管内肿瘤的可行性及效果。方法对21例椎管内肿瘤病人采用小切口半椎板开窗技术,行后正中入路显微镜下切除肿瘤。术后5~7 d复查MRI明确肿瘤切除情况,椎管三维CT确认脊柱骨质破坏程度。结果术中肿瘤全切除21例,术后MRI检查无肿瘤残留,术后三维椎管CT显示棘突和关节突无损伤,脊柱稳定性要素无破坏。病理检查显示:脊膜瘤2例,神经鞘瘤19例。术后切口脑脊液漏1例,加强皮肤缝合后痊愈。随访1~13个月,无复发病例,无切口感染、裂开病例。结论大部分髓外硬膜下肿瘤可通过小切口半椎板开窗手术达到肿瘤全切除,该手术具有减少肌肉、筋膜损伤和骨质破坏,维持脊柱稳定性,满足病人的美容要求及术后并发症少等优点。Objection To investigate the feasibility and effectiveness of the fenestration microsurgery for intraspinal tumor by a small incision and hemilaminectomy.Methods Fenestration operation by small incision and hemilaminectomy were performed in 21 patients with intraspinal tumors via posterior midline approach.The extent of tumor resection was reviewed by MRI 5 to 7 days after the operation,and three dimensional CT was performed to confirm the degree of bone destruction in the spine.Results Total tumor resection was achieved in 21 patients during the operation,there was no residual tumor found by MRI examination,and no injury to the spinous and articular process and damage of spinal stability by 3D spinal canal CT after the operation.Pathological examination showed meningioma in 2 patients and neurilemmoma in 19.Postoperative incision cerebrospinal fluid leakage occurred in 1 patient,and recovery after strengthening skin suture.During a follow-up period of 1 to 13 months,neither patient recurred,nor infection or rupture of incision occurred.Conclusions Total tumor resection can be achieved in most of the spinal subdural tumors through fenestration operation with small incision and hemilaminectomy,which can lessen the damage to the muscle,fascia and bone,can maintain the spinal stability,meet the requirements of the patients for beauty and reduce postoperative complications.

关 键 词：脊髓肿瘤 入路 经后正中 小切口 开窗 半椎板 显微外科手术 

分 类 号：R739.42[医药卫生—肿瘤] R651.2[医药卫生—临床医学]