多通道骶反射监测在经通道显微手术切除腰骶段椎管肿瘤中的应用价值  

Application of multi-channel sacral reflex monitoring in trans-channel microsurgical resection of lumbosacral spinal tumors

作　　者：宋启民[3] 王锐[1] 车峰远 陈春美[1] 谢海树[1] 陈琰[1] 庄源东 Song Qimin;Wang Rui;Che Fengyuan;Chen Chunmei;Xie Haishu;Chen Yan;Zhuang Yuandong(Department of Neurosurgery,Union Hospital of Fujian Medical University,Fuzhou 350001,China;Linyi Key Laboratory of Neurophysiology,Linyi 276000,China;Department of Neurosurgery,Linyi People′s Hospital and Linyi Key Laboratory of Neurophysiology,Linyi 276000,China)

机构地区：[1]福建医科大学附属协和医院神经外科,福州350001 [2]临沂市神经生理学重点实验室,临沂276000 [3]山东省临沂市人民医院神经外科,临沂市神经生理学重点实验室,临沂276000

出　　处：《中华神经外科杂志》2022年第11期1139-1143,共5页Chinese Journal of Neurosurgery

基　　金：福建省卫生教育联合攻关项目(2019-WJ-08)。

摘　　要：目的探讨多通道骶反射监测在经通道显微手术切除腰骶段椎管肿瘤中的应用价值。方法回顾性分析2018年1月至2020年12月福建医科大学附属协和医院神经外科经通道显微手术切除60例胸12椎体及其以下椎管内肿瘤患者的临床资料。术中所有患者均行多通道骶反射监测,将刺激电极固定于阴茎背侧(女性为阴蒂),记录电极分别置于肛门外括约肌、尿道外括约肌(女性为尿道阴道括约肌)、球海绵体肌和(或)坐骨海绵体肌记录信号,同时监测运动诱发电位(MEP)、体感诱发电位(SEP)和肌电图(EMG)。术前、术后7 d、14 d和6个月行日本骨科协会(JOA)评分和疼痛视觉模拟评分法(VAS)评估。结果60例患者共行62例次手术、建立67个通道、切除69个病变。肿瘤全切除55例,大部分切除5例。术中33例骶反射、28例MEP、26例SEP和39例EMG的波形变化达到预警标准。术前、术后7 d、14 d和6个月的JOA评分比较差异有统计学意义(F=109.40,P<0.05);术后7 d、14 d和6个月的JOA评分与术前比较差异均有统计学意义(均P<0.05);术后6个月的JOA评分评估结果:治愈10例(16.7%),显效48例(80.0%),有效2例(3.3%)。术前、术后7 d、14 d和6个月的VAS评分比较差异有统计学意义(F=245.10,P<0.05);术后7 d、14 d和6个月的VAS评分与术前比较差异均有统计学意义(均P<0.05);术后6个月的VAS评估结果:临床治愈6例(10.0%),显效45例(75.0%),有效9例(15.0%),优良率为85.0%(51/60)。结论多通道骶反射监测可以监测阴部感觉神经、运动神经和骶髓功能的完整性,有利于保护经通道显微手术切除腰骶段椎管肿瘤患者的大小便和性功能相关神经传导通路的完整性。Objective To explore the application value of multi-channel sacral reflex monitoring in trans-channel microsurgical resection of lumbosacral spinal tumors.Methods A retrospective study was conducted on the clinical data of 60 patients with intraspinal tumor of thoracic 12(T_(12))and below who underwent trans-channel microsurgical resection at the Department of Neurosurgery,Union Hospital of Fujian Medical University from January 2018 to December 2020.During the operation,all patients underwent multi-channel sacral reflex monitoring.The stimulating electrodes were fixed on the dorsal area of the penis(clitoris in women),and the recording electrodes were placed in the external anal sphincter,external urethral sphincter(the urethrovaginal sphincter in women),bulbocavernosus muscle respectively.and/or the ischiocavernosus muscle.Simultaneous monitoring of motor evoked potentials(MEPs),somatosensory evoked potentials(SEPs)and electromyography(EMGs)was performed.The Japanese Orthopaedic Association(JOA)score and visual analog scale(VAS)were used for assessment before surgery,7 days,14 days and 6 months after surgery.Results Among 60 patients,a total of 62 operations were performed,67 channels were established,and 69 lesions were removed.Tumors were completely removed in 55 patients and mostly removed in 5 patients.The waveform changes of 33 cases of sacral reflex,28 cases of MEP,26 cases of SEP,and 39 cases of EMG reached the warning standard during operation.There was significant difference in the JOA score among pre-operation,7 days,14 days and 6 months post operation(F=109.40,P<0.05).The JOA scores at 7 d,14 d and 6 months post operation were significantly different compared with that prior to operation(all P<0.05).The results of JOA assessment at 6 months post operation showed that 10 cases(16.7%)were cured,48 cases(80.0%)were markedly effective and 2 cases(3.3%)were effective.There was significant difference in the VAS score among pre-operation,7 days,14 days and 6 months post operation(F=245.10,P<0.05).The VAS sc

关 键 词：椎管肿瘤 腰骶部 显微外科手术 监测 生理学 骶反射 通道入路 

分 类 号：R739.42[医药卫生—肿瘤]