成人原发性椎管内肿瘤的外科治疗与疗效分析  

Retrospective analysis of surgical treatment and postoperative follow-up study of adult primary intraspinal tumors

作　　者：高明勇[1] 陶海鹰[1] 卫爱林[1] 余铃[1] 杨博[1] 

机构地区：[1]武汉大学人民医院脊柱外科,武汉市430060

出　　处：《中国肿瘤临床》2017年第20期1029-1033,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:分析总结成人椎管内肿瘤的临床特点、手术方式及术后神经功能恢复及预后。方法:回顾性分析武汉大学人民医院2008年1月至2012年12月69例手术的成人椎管内肿瘤患者的临床资料,分析椎管内肿瘤的病理学特点、治疗方法的选择、治疗前后神经功能ASIA评分变化及预后影响主要因素。结果:成人椎管内肿瘤主要分布于髓外硬膜内(约占总数的61.3%),肿瘤位于胸椎管内比例最高,病理类型以神经鞘瘤及脊膜瘤最多见(两者约占总数的53.5%),采取脊柱后路显露及神经显微外科技术,91%的肿瘤可经全切治愈。ASIA评分显示术后随访神经根性疼痛、肢体感觉运动及括约肌功能均较术前改善明显,差异具有统计学意义。结论:后路椎板切除联合神经显微外科技术,是目前椎管内肿瘤安全有效的外科治疗手段。Objective： To evaluate the diagnosis, surgical treatment, and neurological function recovery after surgery of patients with intraspinal tumors. Methods： The clinical data of 69 patients who suffered from intraspinal tumors and underwent surgery from January 2008 to December 2012 were retrospectively analyzed. Neuroimaging and ASIA scoring were performed to examine the pathological characteristics of tumors and the neurological function of these patients before and after treatment. The major factors affecting prognosis were also probed, and the average follow-up period was 12.2 months. Results： Of the total cases, 62.3% showed intradural extramedullary intraspinal tumors located in the thoracic vertebra. Neurilemoma（Schwannoma） and meningioma were the most common pathological types（53.5%）. Posterior approaches with hemi-and complete-laminectomy were conducted to expose the intraspinal tumors, and the separation and removal of the tumors located at the cervical and thoracic levels were aided with surgical microscopy. The main clinical symptoms, including back pain, radicular neuralgia, sensory disturbance, and motor dysfunction, were significantly improved after surgery, and this observation was supported by the follow-up ASIA scores before and after treatment. Of the involved cases, 91% were successfully treated, and their tumors were totally resected. Conclusion： Total or subtotal intraspinal tumor resection enhanced with surgical microscopy could achieve satisfactory clinical results through posterior hemi-or complete-laminectomy.

关 键 词：椎管内肿瘤 椎板切除术 外科治疗 神经功能 

分 类 号：R739.42[医药卫生—肿瘤]