全脊柱内镜下经椎间孔入路切除腰椎哑铃型肿瘤的疗效分析  

Percutaneous full-endoscopic removalof lumbar dumbbell tumors viatransforaminal approach

作　　者：王锐[1] 陈春美[1] 李锋[2] 江研伟[1] 陈琰[1] 郑师兴[3] 庄源东 周茂超 石松生[1] 杨卫忠[1] Wang Rui;Chen Chunmei;Li Feng;Jiang Yanwei;Chen Yan;Zheng Shixing;Zhiuirig Yuandong;Zhou Maochao;Shi Songsheng;Yang Weizhong(Department of Neurosurgery,Affiliated Union Hospital,Fujian Medical University,Fuzhou350000,China;Department of Neurosurgery,Affiliated Union Hospital Pingtan Branch,Fujian Medical University,Fiizhou 350000,China;Department of Neurosurgery,Affiliated Union Hospital West Branch,Fujian Medical University,Fuzhou 350000,China)

机构地区：[1]福建医科大学附属协和医院神经外科,福州350000 [2]福建医科大学附属协和平潭分院神经外科,福州350000 [3]福建医科大学附属协和西院神经外科,福州350000

出　　处：《中华医学杂志》2020年第4期286-290,共5页National Medical Journal of China

摘　　要：目的探讨应用全脊柱内镜经椎间孔入路切除腰椎哑铃型肿瘤的方法及疗效。方法回顾性分析2018年2月到2019年7月于福建医科大学附属协和医院神经外科经皮全脊柱内镜下经椎间孔入路切除的12例腰椎哑铃型肿瘤患者的临床资料。根据Eden分型,12例中Ⅲ型5例,Ⅳ型7例。应用日本骨科学会(JOA)评分和疼痛视觉模拟评分(VAS)比较手术前后神经功能恢复情况。结果12例全部一期全切除,病理学诊断全部为神经鞘瘤(世界卫生组织Ⅰ级),VAS评分较术前明显改善(P<0.001),JOA评分明显提高,无明显并发症及脊柱不稳定。随访4~20个月,平均14个月,无肿瘤复发和脊柱不稳定。结论在腰椎哑铃型肿瘤治疗中,全脊柱内镜下经椎间孔入路是一种新颖的安全有效手术方式,不仅可以一期切除腰椎椎间孔内外肿瘤,而且最大限度地减少对脊柱正常结构的损伤,避免脊柱不稳定的发生,有助于患者早期康复。Objective To investigate the novel application and effectof Percutaneous Full-Endoscopic transforaminal approach for lumbar dumbbell tumors.Methods A retrospective analysis of 12 cases of lumbar dumbbell tumors was conducted by Percutaneous full-endoscopic transforaminal approach in the Department of Neurosurgery,Fujian Medical University Union Hospital from Feb,2018 to Jul,2019.According to Eden classification,5 cases in typeⅢand 7 cases in typeⅣ.The Japanese Orthopaedic Association(JOA)score and Pain Visual analogue Scale(VAS)were used to compare the recovery of neurological function before and after surgery.Results All the 12 tumors were completely removed in one stage.The pathological reports were all schwannomas(WHO gradeⅠ).The VAS scores were significantly decreased compared with preoperative ones(P<0.001).The JOA scores were significantly improved without obvious complications and spinal instability.Median length of follow-up was 14 months with a range of 4 months to 20 months,there is no tumor recurrence and spinal instability.Conclusion In the treatment of lumbar dumbbell spinal tumor,the full endoscopic transforaminal approach is a novel,safe and effective surgical procedure which removes the tumors intra-foramen and extra-foramen with less damage of spine,smaller possibility of instability and faster recovery.

关 键 词：腰椎椎管肿瘤 微创手术 全内镜 经椎间孔入路 

分 类 号：R73[医药卫生—肿瘤]