超长节段颈髓髓内室管膜瘤手术治疗的微创理念及操作技巧  

Minimally invasive concept and skills in the surgical treatment for ultra-multipe segment cervical intramedullary ependymoma

作　　者：周德祥 林晓风 周东 詹升全 秦琨 郑健涛 甘武 王鹏 Zhou Dexiang;Lin Xiaofeng;Zhou Dong;Zhan Shengquan;Qin Kun;Zheng Jiantao;Gan Wu;Wang Peng(Department of Neurosurgery,Guangdong Provincial People's Hospital,Guangdong Academy Medical Sciences,Guangzhou,Guangdong 510080,China)

机构地区：[1]广东省人民医院,广东省医学科学院神经外科,广州510080

出　　处：《中国微侵袭神经外科杂志》2020年第7期303-305,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨微创理念及操作技巧在切除超长节段(≥5节)颈髓髓内室管膜瘤中的应用。方法回顾性分析24例超长节段颈髓室管膜瘤病人的临床资料。均采用脊髓原位原则、沿肿瘤界面分离、避免热损伤等微创理念及操作技巧切除肿瘤。统计肿瘤全切除率,并比较手术前后脊髓功能状况。结果肿瘤全切除23例,次全切除1例;手术前后脊髓神经功能McCormick分级:术前Ⅰ级9例,Ⅱ级15例;术后1周Ⅰ级8例,Ⅱ级14例,Ⅲ级2例;术后半年Ⅰ级18例,Ⅱ级5例,Ⅲ级1例。术后1周脊髓神经功能较术前变差(P<0.05),术后半年脊髓神经功能较术前明显改善(P<0.05);提示手术对脊髓功能有一定影响,但经康复治疗病人恢复良好。结论应用微创理念及操作技巧切除颈段超长节段髓内室管膜瘤可取得较好疗效。Objective To explore the role of minimally invasive concept and skills in the surgical treatment for ultra-multipe segments(greater than or equal to 5)cervical intramedullary ependymoma(CIE).Methods Clinical data of 24 patients with ultra-multipe segment CIE were analyzed retrospectively,and tumor resection was performed by minimally invasive concept and skills including the spinal cord in-situ principle,tumor interface separation,thermal damage avoidance and so on,then,the rate of tumor total resection was calculated and the spinal cord functions before and after the surgery were compared.Results Total tumor resection was achieved in 23 patients and subtotal resection in 1.McCormick score of spinal cord function showed grade Ⅰ in 9 patients and grade Ⅱ in 15 before the surgery,grade Ⅰ in 8,grade Ⅱ in 14 and grade Ⅲ in 2 at 1 week after the surgery and grad Ⅰ in 18,grade Ⅱ in 5 and grade Ⅲ in 1 at 6 months after the surgery.The neurological function of spinal cord after the surgery was worse than that before the surgery(P<0.05),while the neurological function of spinal cord 6 months after the surgery was obviously improved compared with that before the surgery(P<0.05),which indicates that surgical resection of tumor resulted in spinal cord dysfunction in a certain exten,but their spinal cord dysfunction recovered well after rehabilitation.Conclusion Using minimally invasive concept and skills for resection of ultra-multipe segment CIE can get good therapeutic effects.

关 键 词：室管膜瘤 颈髓 节段 超长 微创理念 操作技巧 显微外科手术 

分 类 号：R739.42[医药卫生—肿瘤] R651.2[医药卫生—临床医学]