臂丛神经鞘瘤的分区、分型和显微外科治疗  

On Regions,Classification,and Microsurgical Treatment of Brachial Plexus Schwannomas

作　　者：吴超[1] 马长城[1] 王振宇[1] 于涛[1] 刘彬[1] 

机构地区：[1]北京大学第三医院神经外科,北京100191

出　　处：《中国微创外科杂志》2017年第12期1060-1063,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市自然科学基金(7144253)

摘　　要：目的探讨臂丛神经鞘瘤的分区、分型以及显微外科治疗要点。方法回顾性分析2010年6月~2017年1月臂丛神经鞘瘤23例资料,根据肿瘤主体相对锁骨的位置分为锁骨上区、锁骨下区、锁骨内侧三角区,根据肿瘤累及臂丛的位置分为近侧型、远侧型以及中间型,后两型又包括前方型和后方型。锁骨上区肿瘤采用胸锁乳突肌后入路、颈后三角内沿皮纹横切口入路以及锁骨上入路,锁骨下区肿瘤行贴近锁骨上缘的锁骨上入路,锁骨内侧三角区肿瘤行切开胸锁乳突肌锁骨头的锁骨上入路。均行显微外科手术切除,术中行神经电生理监测。结果位于锁骨上区18例,锁骨下区1例,锁骨内侧三角区1例,锁骨上区和锁骨下区1例,锁骨上区和锁骨内侧三角区2例;近侧型7例,前-远侧型1例,前-中间型11例,后-中间型4例。23例均完全切除肿瘤,术后病理类型Antoni A型15例,B型8例。术后1例感觉症状加重,2例肌力下降伴感觉症状加重,随访过程中恢复正常,余患者术后症状均消失,随访6~72个月,平均29.8月,无肿瘤复发。结论显微外科治疗臂丛神经鞘瘤安全有效。新的臂丛神经鞘瘤分区有助于指导手术入路的选择,新的分型有助于指导术中操作进而减少术中并发症。Objective To investigate the region distribution, classification, and key points for microsurgical treatment ofbrachial plexus schwannomas. Methods Clinical records of a series of 23 patients with brachial plexus schwannomas surgicallytreated in our department from June 2010 to January 2017 were analyzed retrospectively. According to the location of the tumors, three regions were clarified ： supraclavicular, infraclavicular, and inferior supraclavicular triangle region. Depending on the position of the brachial plexus where the tumor impaired, the tumors were classified into several types ： proximal type, distal type （ anterior-distal and posterior-distal） and medial type （anterior-medial and posterior-medial）. Corresponding operative approaches were selected according to the regions of brachial plexus schwannomas. We selected the posterior sternocleidomastoid approach, the transverse approach in the posterior triangle of the neck, and the supraclavicular approach for supraclavicular tumors. The supraclavicular approach close to the upper margin of the clavicle was used for infraclavicular tumors. And the supraclavicular approach with lanced clavicular head of sternocleidomastoid muscle was used for tumors located in inferior supraclavicular triangle. Microsurgical treatment was completed for all tumors and intraoperative electrophysiological monitor was used. Results There were 18 cases located in the supraclavicular region, 1 case in the infraclavicular, 1 case in the inferior supraclavicular triangle, 1 case in both the supraclavicular and infraclavicular region, and 2 cases in both the supraclavicular and inferior supraclavicular triangle. Seven cases were classified as proximal type, 1 case anterior-distal type, 11 anterior-medial type and 4 posterior-medial type. All the tumors were completely resected. Postoperative pathological results showed 15 cases of Antoni A type and 8 cases of B type. The postoperative sensory symptom was aggravated in 1 patient, and motor deficit with agg

关 键 词：臂丛 神经鞘瘤 显微外科手术 

分 类 号：R739.4[医药卫生—肿瘤]