显微手术治疗颈段椎管内肿瘤预后的影响因素分析  

Prognostic factors of cervical spinal canal tumors treated by microsurgery

作　　者：李道龙[1] 杨振时 沈正东[1] 陈永翱[1] 张玉忠 LI Dao-long;YANG Zhen-shi;SHEN Zheng-dong;CHEN Yong-ao;ZHANG Yu-zhong(Department of Neurosurgery,Second People's Hospital of Lu'an,Lu'an,Anhui Province,237000,China)

机构地区：[1]六安市第二人民医院神经外科,安徽六安237000

出　　处：《颈腰痛杂志》2019年第2期182-184,187,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨显微手术治疗颈段椎管内肿瘤的临床疗效,并分析手术预后的相关影响因素。方法自2015-01-2017-09,收治46例颈段椎管内肿瘤患者,均予以后路手术行肿瘤切除、椎板棘突复合体回植处理。术后随访1年以上,以观察其临床疗效。统计所有患者的性别、年龄、术前JOA评分、肿瘤占位节段、肿瘤切除程度、肿瘤类型等相关因素,并予以多重线性回归分析,以验证上述因素与术后JOA评分之间的关系。结果 (1)所有患者均顺利完成手术,肿瘤全切除39例,近全切4例,次全切3例;肿瘤类型:神经鞘瘤16例,脊膜瘤13例,室管膜瘤6例,肠源性肿瘤4例,神经纤维瘤1例,血管网织细胞瘤5例,错构瘤1例。所有患者均获随访1年以上,回植的椎板均骨性愈合。术前JOA评分为平均(9.7±1.6)分,末次随访时已改善至平均(15.8±3.1)分,差异有统计学意义(P<0.05)。(2)多重线性回归分析显示,术前JOA评分、术中肿瘤切除程度均是手术预后的独立影响因素(P<0.05);而性别、年龄、肿瘤占位节段、肿瘤类型等因素,均与术后JOA评分之间无显著的相关性(P>0.05)。结论采用显微手术治疗颈段椎管内肿瘤的疗效较好,其术前JOA评分和术中肿瘤切除程度可对预后产生重要影响。建议在脊髓神经功能进行性恶化前予以手术,同时在确保手术安全性的前提下,应尽可能做到全切,以达到更好的预后结局。Objective To investigate the efficacy of microsurgery in the treatment of cervical spinal canal tumors and analyze the related prognostic factors. Methods 46 cases of cervical spinal canal tumor were treated from January 2015 to September 2017,all of them were treated with tumor resection and spinal spinous process complex replanting. All patients were followed up for more than 1 years to observe their clinical efficacy. The related factors such as sex, age, preoperative JOA score, tumor occupying segment, tumor resection degree, tumor type and other related factors were statistically analyzed to verify the relationship between the factors and the postoperative JOA score. Results (1)All the patients successfully completed the operation, total tumor resection 39 cases, nearly total cut 4 cases, subtotal cut 3 cases, tumor type: neurilemmoma 16 cases, meningioma 13 cases, ependymoma 6 cases, enteric tumor 4 cases, neurofibroma 1 cases, angio reticuloma 5 cases, and wrong structure tumor 1 cases. All patients were followed up for more than 1 years. The preoperative JOA score was average (9.7±1.6), which had been improved to average (15.8±3.1) at the last follow-up, and the difference was statistically significant (P<0.05).(2)Multiple linear regression analysis showed that preoperative JOA score and intraoperative tumor resection were independent factors (P<0.05), while gender, age, tumor segment, tumor type and other factors were not significantly correlated with postoperative JOA score (P>0.05). Conclusion Microsurgery is effective in the treatment of cervical spinal canal tumors. The preoperative JOA score and the degree of tumor resection can have an important effect on prognosis. It is suggested that the operation should be performed before the neurologic function of the spinal cord is deteriorated. At the same time, full cut should be made as far as possible to ensure the safety of the operation, so as to achieve a better outcome.

关 键 词：颈椎管 显微手术 脊柱肿瘤 神经鞘瘤 影响因素 

分 类 号：R739.4[医药卫生—肿瘤]