腰大肌内神经鞘瘤的临床诊断和手术治疗  

Diagnosis and Surgical Treatment of Intramuscular Schwannoma of Psoas Major

作　　者：吴研飞 朱忠培[1] 李甲振[1] 张岩[1] 肖鹏[1] 毛克政 高延征[2] 廖文胜[1] WU Yan-fei;ZHU Zhong-pei;LI Jia-zhen;ZHANG Yan;XIAO Peng;MAO Ke-zheng;GAO Yan-zheng;LIAO Wen-sheng(Department of Orthopedic,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Spine and Spinal Cord,Henan Provincial People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院骨外科,河南郑州450000 [2]河南省人民医院脊柱脊髓外科,河南郑州450000

出　　处：《河南医学研究》2020年第35期6551-6555,共5页Henan Medical Research

摘　　要：目的总结并分析腰大肌内神经鞘瘤的临床诊断和手术治疗的特点,提高临床医生对该病诊治方面的认知。方法回顾性分析郑州大学第一附属医院及河南省人民医院2013年10月至2019年8月明确诊断并采用手术治疗的腰大肌内神经鞘瘤患者的临床表现、影像资料、手术方法和病理资料,对肿瘤复发情况进行随访。结果共纳入12例资料完整且成功获得随访的患者,其中男4例,女8例,发病年龄23~60岁,中位发病年龄38(32,45)岁。9例(75.0%)患者以腰背痛或下肢运动感觉异常为首发症状,术前疼痛视觉模拟评分(VAS)为4~9分,中位评分为6(5,7)分。CT可见腰大肌内类圆形软组织密度影,内见点状高密度影;MRI平扫及增强可见腰大肌内边界清晰的占位,长T 1混杂长T 2信号,增强扫描后可见不均匀强化。4例患者接受经椎旁肌间隙切除横突入路手术,8例接受腹膜后间隙入路手术,肿瘤均被完整切除,最大的1例瘤体长径为15 cm,术后病理诊断均为神经鞘瘤。随访10~82个月,中位随访时间为24.5(14.5,34.5)个月,随访期间患者复查MRI均无复发,神经功能均改善,末次随访时VAS评分为0~2分,下肢运动感觉异常等症状均恢复正常。结论腰大肌内神经鞘瘤无特异性症状,其CT及MRI表现具有一定的特征,确诊需要病理组织学检查,根据其部位及大小选取相应的手术入路可提高肿瘤完整切除率。Objective To summarize and analyze the characteristics of clinical diagnosis and surgical treatment of intramuscular schwannoma of psoas major,and to improve clinicians’understanding of this disease.Methods The clinical manifestations,imaging findings,surgical methods and pathological diagnosis of patients with intramuscular schwannoma of psoas major diagnosed and treated in the First Affiliated Hospital of Zhengzhou University and Henan Provincial People’s Hospital from October 2013 to August 2019 were retrospectively analyzed.The recurrence of tumor was followed up.Results A total of 12 patients with complete data and successfully followed up were included,including 4 males and 8 females.The age of onset was 23-60 years,and the median age of onset was 38(32,45)years.Nine patients(75.0%)had low back pain or lower limb dyskinesia or paresthesia as the first symptoms.The preoperative visual analogue score(VAS)for pain was 4-9 points,and the median score was 6(5,7)points.CT showed round-like soft tissue density shadows in the psoas major muscle,and dot-like high-density shadows were seen inside.MRI showed there was space-occupying lesion with clear boundary in psoas major,long T 1 mixed with long T 2 signals,and uneven enhancement could be seen after enhanced scanning.Four patients underwent surgery through the paraspinal muscle space(transverse process resection),and 8 patients underwent surgery through the retroperitoneal space.The tumors were all completely removed,and major axis of the largest tumor was 15 cm.Postoperative pathological diagnosises were all schwannoma.The follow-up period was 10-82 months,and the median follow-up time was 24.5(14.5,34.5)months.During the follow-up period,the patients had no recurrence after reexamination of MRI,and the neurological function of patients all improved.At the last follow-up,the VAS score was 0-2,and symptoms such as lower limb dyskinesia and paresthesia all returned to normal.Conclusion There are no specific symptoms for intramuscular schwannoma of psoas major.C

关 键 词：神经鞘瘤 腰大肌 诊断 手术入路 

分 类 号：R739.4[医药卫生—肿瘤]