高颈段椎管内肿瘤的显微手术治疗  

Microneurosurgery for high cervical intraspinal tumors(report of 50 cases)

作　　者：刘亚军[1] 王金龙[1] 郭运发[1] 罗坤[1] LIU Ya-jun;WANG Jin-long;GUO Yun-fa;LUO Kun(Department of Neurosurgery, the First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China)

机构地区：[1]新疆医科大学第一附属医院神经外科中心,乌鲁木齐830054

出　　处：《中国临床神经外科杂志》2017年第12期804-807,共4页Chinese Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(81660471)

摘　　要：目的探讨高颈段椎管内肿瘤显微手术方法的选择及其疗效。方法回顾性分析2010年1月至2016年12月显微手术治疗的50例高颈段椎管内肿瘤的临床资料,其中26例在半椎板切除条件下行切除肿瘤;24例在全椎板切除条件下切除肿瘤,术后再应用内固定。结果术后病理示神经鞘瘤23例,脊膜瘤16例,室管膜瘤8例,星形细胞瘤2例,血管母细胞瘤1例。肿瘤全切42例,次全切8例。术后7例出现并发症,其中6例对症处理好转出院,1例死亡。49例术后随访3个月至3年,未见肿瘤复发,脊柱稳定性好;按日常生活活动能力量表评价预后状况,术后生活质量改善39例,无变化7例,下降3例;8例次全切残余肿瘤体积无明显变化,其余无复发;所有病人随访期间影像学检查无颈椎不稳现象。结论应用神经显微技术切除高颈段椎管内肿瘤效果好,可减少神经损伤并发症。在维持颈椎稳定性方面,要根据占位与脊髓的位置关系选择手术方式。Objective To explore microneurosurgical technique to treat high cervical intraspinal tumors.Methods The clinical data of50patients with high cervical intraspinal tumors,of whom,26underwent half laminectomy and resection of the tumors and24the laminectomy,resection of the tumors and internal fixation,from January,2010to December,2016,were analyzed retrospectively.Results The postoperative pathological examination showed that of these50patients,23had neurilemmomas,16spinal meningiomas,8ependymomas,2astrocytomas and1hemangioblastoma.Total resection of the tumors was achieved in42patients and subtotal resection in8.The postoperative complications occurred in7patients,of whom,6were cured and1died.No tumor recurrence was observed and spinal stability is good in49patients who were followed up from3months to3years.The postoperative quality of life was improved in39cases,unchanged in7and decreased in3during the following up according to activities of daily living test.Conclusions The curative effects of microneurosurgery on the patients with high cervical intraspinal tumors are good,but the surgical procedure should be selected according to the location of the intraspinal tumors in order to maintain the stability of the cervical spine.

关 键 词：椎管内肿瘤 高颈段椎管 显微手术 颈椎稳定性 疗效 

分 类 号：R739.42[医药卫生—肿瘤] R651.11[医药卫生—临床医学]