复杂脊髓脂肪瘤的临床分型和手术治疗  

Clinical classification and surgical treatment of complex spinal cord lipomas

作　　者：修波[1] 李萃萃 萧凯[2] 林和璞[1] 戴宜武 Xiu Bo;Li Cuicui;Xiao Kai;Lin Hepu;Dai Yiwu(Department of Neurosurgery,the 7th Medical Center of PLA General Hospital,Beijing 100700,Chin;Department of Neurosurgery,Tsinghua University Yuquan Hospital,Beijing 100040,China)

机构地区：[1]解放军总医院第七医学中心神经外科,北京100700 [2]清华大学玉泉医院神经外科,北京100040

出　　处：《中华神经外科杂志》2020年第11期1103-1108,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨复杂脊髓脂肪瘤的临床分型、手术治疗方法及效果。方法回顾性分析2008年1月至2017年1月解放军总医院第七医学中心神经外科(204例)和清华大学玉泉医院神经外科(199例)收治的403例复杂脊髓脂肪瘤患者的临床资料。所有患者均行手术切除病变,观察手术效果和并发症。根据病变手术前、后的影像学(MRI)特征、术中所见,403例复杂脊髓脂肪瘤可分为背侧型(51例)、过渡型(289例)和混杂型(63例)。其中,背侧型可分为简单型(42例)和髓包瘤型(9例)两个亚型,混杂型可分为圆锥型(56例)和瘤包髓型(7例)两个亚型。通过临床随访和影像学随访评估患者的预后。结果复杂脊髓脂肪瘤完全切除或次全切除287例(71.2%),其中背侧型占82.3%(42/51),过渡型占82.7%(239/289),混杂型占9.5%(6/63)。403例患者均随访3年,原有症状加重或出现新发症状38例(9.4%),其中混杂型23例,过渡型15例。术后3年症状无进展生存率为90.6%(365/403),其中背侧型为100.0%(51/51),过渡型为94.8%(274/289),混杂型为63.5%(40/63)。结论复杂型脊髓脂肪瘤的正确分型有助于预判手术风险、指导手术并粗略评估患者的预后;混杂型完全或次全切除率最低,预后最差。脊髓再拴系和神经发育不良可能是远期症状加重的主要原因。Objective To analyze the clinical classification,surgical treatment and outcome of complex spinal cord lipomas.Methods The clinical data of 403 patients with complex spinal cord lipomas from January 2008 to January 2017 were retrospectively analyzed.Among 403 cases,204 were admitted to Department of Neurosurgery of the 7th Medical Center of PLA General Hospital and 199 cases to Department of Neurosurgery of Tsinghua University Yuquan Hospital.All patients underwent lipoma resection,and their outcomes and complications were documented.According to MRI features before and after operation and intraoperative findings,403 cases with complex spinal cord lipomas were divided into dorsal type(51 cases),transitional type(289 cases)and chaotic type(63 cases).Among them,dorsal type was subdivided into simple type(42 cases)and cord-wrapping tumor type(9 cases),and chaotic type was subdivided into conus type(56 cases)and tumor-wrapping cord type(7 cases).The outcome was evaluated by clinical and MRI follow-up.Results Total or subtotal resection was performed in 287 cases(71.2%),including 42 cases(82.3%)of dorsal type,239 cases(82.7%)of transitional type and 6 cases(9.5%)of chaotic type.The follow-up period was 3 years post operation.The symptoms deteriorated in 38 cases(9.4%),including 23 cases of chaotic type and 15 cases of transitional type.During the 3 years post operation,the rate of symptomatic progression-free survival(PFS)was 90.6%(365/403)with 100.0%(51/51)in dorsal type,94.8%(274/289)in transitional type and 63.5%(40/63)in chaotic type.Conclusions The correct classification of complex spinal cord lipomas can help predict the surgical risk,guide the operation and roughly evaluate the prognosis.The rate of total or subtotal resection for chaotic lipomas seems to be the lowest with the worst outcome.Retethering and neurodysplasia may be the main causes of the long-term deterioration of symptoms.

关 键 词：椎管闭合不全 脂肪瘤 分型 神经外科手术 脊髓拴系 

分 类 号：R739.42[医药卫生—肿瘤]