先天性皮毛窦及其伴发神经管畸形的手术治疗  

Surgical treatment of congenital dermal sinus tract of spine and neural tube defect

作　　者：王乐凯[1] 尚爱加[1] 乔广宇[1] 陶本章 杨昌浩 WANG Le-kai;SHANG Ai-jia;QIAO Guang-yu(Department of Neurosurgery,Chinese PLA General Hospital,Beijing 100853,China;Corresponding author)

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《临床神经外科杂志》2018年第5期362-366,共5页Journal of Clinical Neurosurgery

基　　金："首都特色"基金(Z171100001017140);解放军总医院临床科研扶持基金(2016FC-CXYY-100);解放军总医院科技创新苗圃基金(17KMM11)

摘　　要：目的探讨先天性皮毛窦及其伴发的神经管畸形的诊断要点与手术方法及其疗效。方法回顾性分析2008年1月至2017年12月解放军总医院神经外科收治的43例先天性皮毛窦患者的临床资料。分类计数皮毛窦的外观特点、部位及伴发的神经管畸形种类。全部患者均经MRI检查,并行显微手术治疗。采用脊柱裂神经功能量表(SBNS)评估手术疗效。术后随访6个月～8年。结果外观特征多为局部皮肤凹陷(23/43,53. 4%);皮毛窦部位以腰骶部最多(25/43,58. 1%);合并的神经管畸形以脊髓拴系最多(22/43,51. 2%)。本组患者手术的总有效率为90. 7%(40/43)。结论先天性皮毛窦的皮损特点各异,皮损以局部皮肤凹陷多见。发病部位沿躯干背侧神经中轴分部,以腰骶部多见。先天性皮毛窦往往伴发多种神经管畸形及脊髓先天性肿瘤,因此相应部位的MRI检查是必要的。在手术处理先天性皮毛窦的同时,须一并处理并发的神经管畸形相关疾病,能获得较好的效果。Objective To investigate the diagnosis, surgical treatment and efficacy of congenital dermal sinus tract of the spine and neural tube defect. Methods The clinical data of 43 patients with congenital dermal sinus tract of the spine and neural tube defect admitted to the Department of Neurosurgery, Chinese PLA Ceneral Hospital from January 2008 to December 2017 were analyzed retrospectively. The skin abnormalities characteristics of dermal sinus, location, and the types of neural tube defects were counted. According to the imaging findings, all the patients were treated with microsurgery Spinal bifida neurological scale （SBNS） was used to evaluate the efficacy of surgical treatment. The follow-up time ranged from 6 to 96 months. Results The most common skin abnormalities was dimples （23/43,53.4%）. Dermal sinuses occur frequently at the lumbosacral regions and account for 58.1% （25/43） of all cases. The most common coexistence of tethered cord with congenital dermal sinus tract was 51.2% （22/43）. The total effective rate of 43 patients withCongenital dermal sinus tract of the spine and neural tube defect after procedure was 90.7% （40/43 ）. Conclusions Skin abnormalities of congenital dermal sinus tract is diverse, usually seen in the midline of lumbosacral regions. These tracts may be accompanied with other pathologies such as lipoma, split cord malformation ,tethered cord ,filum abnormality and congenital tumors. MRI scan is necessary and treatment includes resection of tract with intradural exploration. The risks associated with surgical exploration are very low and the benefit is high.

关 键 词：先天性皮毛窦 神经管畸形 显微外科手术 预后 

分 类 号：R651[医药卫生—外科学]