颈椎管内肿瘤的微侵袭手术治疗  

Minimally invasive approaches for resection of cervical intraspinal tumors

作　　者：李甲 江晓航 胡鑫奔 应广宇 朱永坚 Li Jia;Jiang Xiaohang;Hu Xinben;Ying Guangyu;Zhu Yongjian(Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang310009, China;Department of Neurosurgery, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University NingboMedical Center, Ningbo, Zhejiang 315040, China;Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, Fujian 350007,China)

机构地区：[1]浙江大学医学院附属第二医院神经外科,杭州310009 [2]宁波市医疗中心李惠利东部医院,台北医学大学宁波医疗中心神经外科,315040 [3]福建省立医院神经外科,福州350007

出　　处：《中国微侵袭神经外科杂志》2019年第6期249-252,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：浙江省科技计划项目面上科研社会发展项目(编号:2007C33042);浙江省科技计划项目重点研发计划(编号:2017C03018)

摘　　要：目的探讨颈椎管内肿瘤微侵袭手术的有效性和安全性。方法回顾性分析34例颈椎管内肿瘤微侵袭手术的临床资料,经椎板间隙入路7例,经半-半椎板入路10例,经半椎板入路17例。采用日本骨科学会(JOA) 17分法评估病人手术前后的脊髓功能状态,并进行随访分析。结果手术时间(129.48±34.51) min,术中出血量(100.59±84.64) ml,术中测量肿瘤最大径(2.71±1.13) cm。所有病人获肿瘤全切除。术后病理:神经鞘瘤26例,神经纤维瘤3例,脊膜瘤3例,内胚层囊肿及海绵状血管瘤各1例。术前JOA评分(9.85±2.11)分,术后2周JOA评分(15.03±0.97)分,脊髓功能改善率为(72.33±10.48)%,达到良好水平。随访(50.28±15.37)个月,未发现颈椎不稳病例;1例脑脊液漏再次手术修补后愈合,1例肿瘤复发予以再次手术。结论根据不同的肿瘤情况采用相应的微侵袭手术方式,可以有效处理大多数颈椎管内肿瘤。Objective To explore the efficacy and safety of minimally invasive surgery for cervical intraspinal tumors. Methods Clinical data of 34 patients with cervical intraspinal tumors undergoing minimally invasive surgery were analyzed retrospectively,including via interlaminar approach in 7 patients, hemi-semi-laminectomy approach in 10 and hemilaminectomy approach in 17. The spinal cord function was evaluated by Japanese orthopaedic association(JOA) 17 scores scale before and after the surgery, and the follow-up was performed in all the patients. Results The operation time was 129.48±34.51 min, the blood loss was 100.59±84.64 ml,and the maximum diameter of tumors was 2.71 ±1.13 cm according to the intraoperative measurement. Total tumor resection was achieved in all the patients. The postoperative pathology showed schwannoma in 26 patients, neurofibroma in 3, meningioma in 3,endodermal cyst in 1 and cavernous hemangioma in 1. The JOA scores were 9.85±2.11 before the surgery and 15.03±0.972 2 weeks after the surgery, and the improvement rate of the spinal cord function was 72.33%±10.48%, achieving a good level. After a follow-up period of 50.28 ±15.37 months, there was no patient with cervical instability, 1 patient with cerebrospinal fluid leakage cured after reoperation and 1 recurrent patient underwent reoperation. Conclusion According to the different tumor conditions, the corresponding minimally invasive approach can be used to effectively resect most cervical intraspinal tumors.

关 键 词：脊髓肿瘤 入路 椎板间隙 入路 半-半椎板 入路 半椎板 显微外科手术 

分 类 号：R739.42[医药卫生—肿瘤]