体感诱发电位监测在椎管内神经鞘瘤手术中的应用研究  

The application of somatosensory evoked potential in the operation of intraspinal neurilemmoma

作　　者：何虹兵 吴晨瑞 程予琦 毛岚田 杜梦然 周强[1] 廖正步[1] HE Hongbing;WU Chenrui;CHENG Yuqi;MAO Lantian;DU Mengran;ZHOU Qiang;LIAO Zhengbu(Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《现代医药卫生》2020年第19期3056-3058,共3页Journal of Modern Medicine & Health

基　　金：国家自然科学基金项目(81771355)。

摘　　要：目的探讨体感诱发电位(SEP)监测在椎管内神经鞘瘤手术中的应用价值。方法将97例椎管内神经鞘瘤显微手术治疗患者分为对照组(不予以术中SEP监测,45例)和监测组(术中予以SEP监测,52例)。观察术中SEP变化情况,比较肿瘤全切率、脊髓功能、疼痛及肿瘤复发情况。结果监测组患者中,16例(31%)术中SEP波幅下降50%以上或潜伏期延长10%,停止手术操作后,13例恢复至术前水平,2例较术前差,1例未恢复。监测组术后肌力减退2例(5.8%),对照组为7例(15.6%),组间比较差异有统计学意义(P<0.05)。监测组术后4例(7.7%)出现感觉减退,对照组为8例(17.8%),组间比较差异有统计学意义(P<0.05)。术前患者视觉模拟疼痛评分(VAS评分)组间比较差异无统计学意义(P>0.05),术后监测组VAS评分低于对照组(P<0.05)。监测组肿瘤全切率96.1%,高于对照组的80.0%(P<0.05);术后随访1年,所有患者均未见复发。结论术中SEP监测可有效保护椎管内神经鞘瘤显微手术患者脊髓神经功能,提高肿瘤切除率,缓解术后疼痛。Objective To investigate the application value of somatosensory evoked potential(SEP)in the operation of intraspinal neurilemmoma.Methods 97 cases of intraspinal neurilemmoma receiving operation treatment were divided into control group(45 cases)without intraoperative monitoring of SEP and monitoring group(52 cases)with intraoperative monitoring of SEP.The changes of SEP were observed,and the total tumor resection rate,spinal cord function,pain degree and recurrence rate were compared.Results In monitoring group,the wave amplitude were decreased more than 50%or the latency were prolonged more than 10%in 16 cases(31%),among which,after stopping the operation,the wave amplitude of 13 cases recovered to the preoperative level,the wave amplitude of 2 cases were worse than the preoperative level,and 1 case was not recovered.Postoperative sensory function of spinal cord was improved or without changes in 48 cases(92.3%)of monitoring group,and 37 cases(82.2%)of control group,and the difference was significant(P<0.05).There was no significant difference of visual analogue pain score(VAS score)between the two groups before operation(P>0.05),but after operation,that in monitoring group was lower than control group(P<0.05).The total tumor resection rate of monitoring group was 96.1%,higher than the 80.0%of control group(P<0.05).After 1 year of follow-up,there was no recurrence in both groups.Conclusion Intraoperative monitoring of SEP could effectively protect the spinal nerve function in in patients with intraspinal neurilemmoma undergoing microsurgery,improve the tumor resection rate,and relieve postoperative pain.

关 键 词：椎管内神经鞘瘤 神经电生理监测 体感诱发电位 脊髓神经功能 显微手术 

分 类 号：R616.2[医药卫生—外科学]