椎旁切口双入路切除胸腰段Eden Ⅱ型和Ⅲ型椎管内外沟通性肿瘤的临床疗效  

Clinical efficacy of paraspinal approach with two lateral incisions for resection of dumbbell-shaped intra-and extra-thoracolumbar spinal tumors of Eden type Ⅱ and Ⅲ

作　　者：周渊 林毅兴 朱林 白万山 成惠林 Zhou Yuan;Lin Yixing;Zhu Lin;Bai Wanshan;Cheng Huilin(Department of Neurosurgery,General Hospital of PLA Eastern Theater Command,Nanjing 210002,China;Department of Neurosurgery,Zhongda Hospital Affiliated with Southeast University,Nanjing 210009,China)

机构地区：[1]中国人民解放军东部战区总医院神经外科,南京210002 [2]东南大学附属中大医院神经外科,南京210009

出　　处：《中华神经外科杂志》2021年第2期149-153,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81271377);全军医学科技青年培育计划(16QNTO42)。

摘　　要：目的初步探讨一期椎旁切口双入路切除胸腰段Eden Ⅱ型和Ⅲ型椎管内外沟通性肿瘤的临床疗效。方法回顾性分析2013年8月至2019年4月中国人民解放军东部战区总医院神经外科收治的12例胸腰段椎管内外沟通性肿瘤患者的临床资料,其中Eden分型Ⅱ型5例,Ⅲ型7例;术前McCormick分级Ⅰ级8例,Ⅱ级1例,Ⅲ级2例,Ⅳ级1例。所有患者均行一期椎旁切口双入路肿瘤切除术,3例行椎弓根螺钉内固定术。门诊随访患者的症状改善情况、有无轴性症状、McCormick分级以评估疗效,复查脊柱MRI,观察多裂肌有无萎缩以及脂肪浸润程度(由轻至重分为Ⅰ~Ⅲ度)。结果12例患者的肿瘤均全切除,术中横突部分医源性破坏3例。病理学结果显示,神经鞘瘤10例,原始神经外胚层肿瘤、黑色素细胞瘤各1例。术后1例患者出现泌尿系感染,经抗感染治疗后明显,缓解。术后McCormick分级Ⅰ级8例,Ⅱ级1例,Ⅲ级2例,Ⅳ级1例。12例患者的随访时间为(32.1±21.7)个月(6~62个月)。至末次随访,6例症状改善,5例症状稳定,1例(原始神经外胚层肿瘤)症状加重;Ⅱ例MrCormirk分级Ⅳ级改善为Ⅲ级,1例Ⅲ级改善为Ⅱ级,1例Ⅲ级加重为Ⅳ级,8例Ⅰ级和1例Ⅱ级患者的分级无变化;仅1例出现轴性疼痛症状;脊柱MRI显示,1例患者肿瘤复发,所有患者内固定均在位,无松动,骨质愈合好,脊柱稳定性良好,10例患者肿瘤侧的多裂肌萎缩,12例患者的多裂肌均有Ⅰ~Ⅱ度的脂肪浸润。结论初步观察发现,一期椎旁切口双入路切除胸腰段Eden Ⅱ型和Ⅲ型椎管内外沟通性肿瘤,可以达到肿瘤全切除,临床疗效较好。Objective To explore the clinical efficacy of resection of dumbbell-shaped intra-and extra-thoracolumbar spinal tumors(DIEST)of Eden type Ⅱ and Ⅲ through one-stage paraspinal approach with two lateral incisions.Methods A total of 12 cases of DIEST were admitted to Department of Neurosurgery,General Hospital of PLA Eastern Theater Command from August 2013 to April 2019 and retrospectively analyzed in this study.Among them,5 cases were Eden type Ⅱ 7 were type Ⅲ.According to the McCormick classification,there were 8 cases of level Ⅰ,1 of level Ⅱ,2 of level Ⅲ,and 1 of level Ⅳ prior to operation.All patients underwent tumor resection through one-stage paraspinal approach wth two lateral incisions,and 3 patients underwent internal fixation-with pedicle screws.At outpatient follow-up,the patientsf symptom improvement and axial symptoms were assessed,and McCormick classification was used for assessment of therapeutic effect.Whether the patient’s multifidus had atrophy was identified and the fatty infiltration degree was graded as Ⅰ(slight)to Ⅲ(severe).Results Total resection was achieved in all 12 cases.Intraoperative iatrogenic destruction of transverse processes occurred in 3 patients.The pathological results revealed 10 cases of schwannoma,1 case of primitive neuroectodennal tumor and 1 case of melanocytoma.Postoperative urinary infection occurred in 1 case,which was significantly relieved after anti-infection treatment.Based on the McCormick classification system,there were 8 cases of level Ⅰ,1 of level Ⅱ,2 of level Ⅲ,and 1 of level Ⅳ post operation.The follow-up duration of 12 patients was 32.1±21.7 months(6-62 months).By the last follow-up,6 cases had improved symptoms,5 cases had stable symptoms,and 1 case(primitive neuroectodermal tumor)had aggravated symptoms;McCormick level Ⅳ changed to level Ⅲ in 1 case,level Ⅲ to Ⅱ in 1 case,level Ⅲ to Ⅳ in 1 case,while the remaining cases of level Ⅰ and Ⅱ were unchanged;only 1 patient developed symptoms of axial pain;spinal MRI

关 键 词：脊髓肿瘤 硬膜外肿瘤 显微外科手术 治疗结果 椎旁肌 

分 类 号：R738.1[医药卫生—肿瘤]