脊髓海绵状血管瘤的临床特征及显微外科手术治疗预后分析  

Clinical Feature and Prognosis of Microsurgery of Spinal Cord Cavernous Hemangioma

作　　者：史良[1] 阎涛[1] 王科大[1] 刘龙奇 王汉斌[1] 乔京元[1] 苏亦兵[1] SHI Liang;YAN Tao;WANG Keda;LIU Longqi;WANG Hanbin;QIAO Jingyuan;SU Yibing(Department of Neurosurgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院神经外科,北京市100035

出　　处：《实用心脑肺血管病杂志》2022年第3期117-122,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：北京市属医院科研培育项目(PX2020018);北京积水潭医院学科骨干培养计划(XKGG202115);北京积水潭医院医工企交叉培育项目(YGQ-201906)。

摘　　要：背景脊髓海绵状血管瘤(SCCH)较为罕见,约占髓内肿瘤的5%,其早期症状隐匿,但瘤体常反复出血,可导致严重的脊髓损伤甚至截瘫,极易误诊漏诊,延误手术时机并增加手术风险,故需早期识别。目的探讨SCCH的临床特征及显微外科手术治疗预后。方法回顾性选取2005年1月至2021年1月北京积水潭医院神经外科收治的17例SCCH患者,均采用显微外科手术治疗,分析其临床表现、影像学特征、手术及随访情况,分别于入院时、出院时及出院后6个月采用疼痛视觉模拟量表(VAS)评估疼痛程度,采用McCormick脊髓功能分级评估脊髓损伤情况,采用欧洲脊髓病评分(EMS)评估预后情况。结果17例SCCH患者中,男7例,女10例;年龄26~67岁。首发症状表现为颈肩、腰背或肢体不适感;疾病分类:急性起病型2例(11.8%),缓解复发型10例(58.8%),进行性加重型5例(29.4%)。脊髓磁共振成像(MRI)平扫+增强扫描可见脊髓相应节段占位性病变。入院时17例患者VAS评分为0~6分,平均(3.2±1.2)分;McCormick脊髓功能分级:Ⅰ级2例,Ⅱ级7例,Ⅲ级5例,Ⅳ级3例;EMS为7~16分,平均(11.8±2.3)分。出院时患者VAS评分为0~4分,平均(1.8±1.1)分,低于入院时(t=3.55,P=0.001)。McCormick脊髓功能分级:Ⅰ级5例,Ⅱ级7例,Ⅲ级4例,Ⅳ级1例。EMS为7~17分,平均(12.8±2.7)分;所有患者术后EMS高于术前EMS。随访6个月时患者VAS评分为0~4分,平均(1.2±1.1)分,低于入院时(t=5.07,P<0.001)。McCormick脊髓功能分级:Ⅰ级12例,Ⅱ级4例,Ⅲ级1例,Ⅳ级0例。EMS为9~17分,平均(14.5±2.3)分;所有患者随访EMS高于术前EMS。每6~12个月定期复查脊髓MRI,未见复发或再次出血。结论SCCH作为一类罕见的脊髓内病变,其症状多变,手术风险较高。对于有临床症状进展的SCCH患者,早期行显微外科手术是最佳治疗选择,但术前应制定个体化手术方案,术中精细操作,可获得较满意的预后。而对于症状轻微或处于缓解期的患Background Spinal cord cavernous hemangioma(SCCH)is very rare,accounting for about 5%of intramedullary lesions.Its early symptoms are variable,but the tumor body often bleeds repeatedly,which can lead to severe spinal cord injury and even paraplegia,and it is very easy to miss diagnosis and misdiagnose,delay the timing of surgery,and increase the risk of surgery.Therefore,early identification of SCCH is needed.Objective To investigate the clinical features and prognosis of microsurgery of SCCH.Methods A retrospective analysis was preformed in 17 patients with SCCH in the Department of Neurosurgery,Beijing Jishuitan Hospital from January 2005 to January 2021.Patients were all treated by microsurgery.The clinical manifestation,imaging features,operative findings,and prognosis were analyzed.At admission,discharge and 6 months after discharge,Visual Analogue Scale(VAS)was used to assess the degree of pain,the McCormick spinal cord function grade was used to assess the situation of spinal cord injury and European Myelopathy Score(EMS)was used to assess the prognosis.Results Among the 17 patients with SCCH,there were 7 males and 10 females;the age ranged from 26 to 67 years old.The first symptom was discomfort of neck,shoulder,waist and back or limbs;disease classification:2 cases of acute onset type(11.8%),10 cases of remission and relapse type(58.8%),and 5 cases of progressive aggravation type(29.4%).Spinal cord magnetic resonance imaging(MRI)plain scan+enhanced scan showed space-occupying lesions in the corresponding segments of the spinal cord.The VAS score of 17 patients at admission was 0-6,with an average of(3.2±1.2);McCormick spinal cord function classification:2 cases were gradeⅠ,7 cases were gradeⅡ,5 cases were gradeⅢ,and 3 cases were gradeⅣ;EMS ranged from 7 to 16 points,with an average of(11.8±2.3)points.The VAS score of the patients at discharge was 0-4,with an average of(1.8±1.1),which was lower than that at admission(t=3.55,P=0.001).McCormick spinal cord function classification:5 cases were gr

关 键 词：血管瘤 海绵状 脊髓 显微外科手术 临床特征 预后 

分 类 号：R732.2[医药卫生—肿瘤] R322.81[医药卫生—临床医学]