椎管内海绵状血管瘤的外科干预时机和临床疗效  

Timing of surgical intervention and clinical efficacy of intra-vertebral cavernous hemangioma

作　　者：成惠林 周渊 苗伟 励宁 朱林 林毅兴 苏正 Cheng Huilin;Zhou Yuan;Miao Wei;Li Ning;Zhu Lin;Lin Yixing;Su Zheng(Department of Neurosurgery,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院神经外科,南京210009 [2]东部战区总医院神经外科

出　　处：《中国脑血管病杂志》2021年第10期698-703,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(82071393)。

摘　　要：目的初步探讨椎管内海绵状血管瘤的外科干预时机和临床疗效。方法回顾性分析2006年5月至2021年5月东南大学附属中大医院神经外科(11例)及东部战区总医院神经外科(17例)连续收治的28例椎管内海绵状血管瘤患者的临床资料,其中27例行后正中入路显微外科手术治疗,1例随访观察。所有患者治疗前行脊柱MRI平扫+增强扫描。对于无症状、MRI示病灶微小、无明显脊髓受压表现的患者,先观察,每半年随访检查MRI,如出现相关症状或影像学检查示病灶明显增大,则行手术治疗;有明显症状(包括相应部位疼痛、肢体运动感觉障碍、大小便功能障碍)者均行手术治疗;急性发病、MRI示髓内出血明显者,入院后均尽快手术,包括急性发病早期(发病后3 d内)和急性发病中期(发病后3 d~3周)患者;非急性发病者均择期手术。对所有患者进行术后6~24个月的门诊随访,内容包括症状改善状况及脊髓功能状态的评估(采用McCormick分级及脊柱MRI)。结果(1)治疗前临床资料:28例患者中,急性发病8例(均为髓内型),非急性发病20例(含1例未手术患者);治疗前McCormick分级Ⅱ级6例,Ⅲ级17例,Ⅳ级5例。按节段分,颈段9例(32.1%),胸段15例(53.6%),腰段4例(14.3%,包括腰骶部及全身多发1例)。按病变与脊髓关系分,髓内型18例(急性发病8例,非急性发病10例;肌力分级:0~Ⅰ级3例,Ⅱ~Ⅲ级6例,Ⅳ~Ⅴ级9例),蛛网膜下腔3例,硬膜外或椎管沟通性占位7例。(2)治疗方式:27例最终行手术治疗,其中3例蛛网膜下腔内及7例硬膜外或椎管沟通性占位均行择期手术;9例非急性发病、肌力Ⅳ级以上的髓内型患者行择期手术;8例急性发病并有下肢瘫痪的髓内型患者中,5例在急性发病早期手术,3例在急性发病中期手术。1例髓内型患者未行手术,继续观察中。(3)手术治疗效果:27例手术患者术后即刻临床好转1例,无效25例,加重1例;McCormick分级Ⅱ级6例,Objective To investigate the surgical intervention opportunity and clinical effect of intra-vertebral cavernous hemangioma.Methods Clinical data of 28 patients with intra-vertebral cavernous hemangioma admitted to the Department of Neurosurgery,Zhongda Hospital Affiliated to Southeast University(11 cases)and General Hospital of East Military Command(17 cases)from May 2006 to May 2021 were retrospectively analyzed.Among them,27 underwent posterior median approach microsurgery and 1 case was followed up.All patients underwent non-enhanced and enhanced MRI of the spine before treatment.For those with no symptoms,small lesions or without cord compression,observations and follow-up MRI every six months were recommended.If there were related symptoms or imaging examination showing that the lesion was significantly enlarged,surgery would be performed.All patients with obvious symptoms(including pain in corresponding parts,motor or sensory disturbance of limbs and dysfunction of urine and feces)were treated with surgery.Patients with acute onset and MRI showing obvious intramedullary bleeding were operated on as soon as possible after admission.Operations were categorized into early-acute(<3 d after the onset)and mid-acute(3 d-3 w after the onset).All patients with non-acute onset underwent elective surgery.All cases were followed up in outpatient clinic for 6-24 months,including symptom improvement and spinal functional status assessment using McCormick grading and spinal MRI.Results(1)Clinical data before treatment:among 28 patients,8 cases were acute patients(all intramedullary type)and 20 cases were non-acute onset(including 1 case of non-acute onset without operation).Before operations,6 cases were McCormick graded asⅡ,17 asⅢand 5 asⅣ.According to lesion segments,9(32.1%)patients were with cervical lesions,15(53.6%)thoracic and 4 lumbar lesions(14.3%,including lumbosacral region and 1 case with multiple sites in the whole body).According to the relationship between lesions and spinal cord,18 patients had intra

关 键 词：脊髓 椎管 海绵状血管瘤 外科治疗 手术时机 

分 类 号：R651.12[医药卫生—外科学]