显微手术切除椎管内脊膜瘤的技巧和效果  

Microsurgical removal of intraspinal meningioma:Skill required and surgical effect

作　　者：董伟杰 苏洛希 刘馨蔓 段成斌 王福涓[1] 吴新建[1] DONG Weijie;SU Luoxi;LIU Xinman;DUAN Chengbin;WANG Fujuan;WU Xinjian(Department of Neurosurgery,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院神经外科,广州510080

出　　处：《中华显微外科杂志》2022年第6期639-642,共4页Chinese Journal of Microsurgery

基　　金：广东省自然科学基金(S2013010015837)。

摘　　要：目的探讨椎管内脊膜瘤的显微手术的治疗效果。方法回顾性分析2003年1月-2022年3月中山大学附属第一医院神经外科收治的的椎管内120例脊膜瘤患者的临床资料,其中女90例,男30例;年龄14~85岁,平均54岁。McCormick临床脊髓神经功能分级:I级29例,II级59例,III级25例,IV级7例。均经显微手术治疗。术后3个月内来院复诊,之后采用复诊、电话等随访,复查脊髓神经功能及MRI,对患者术前、术后和后期随访的神经功能及影像学改变进行分析。结果120例中,113例全切除病灶,7例大部分切除。无感染及脑脊液漏等并发症,无死亡病例。术后随访3个月~10年,3个月时95例症状(如麻木、疼痛、运动受限等)好转甚至完全消失,23例症状同术前,2例加重。术后3个月时,95例(79.2%)症状好转,23例(19.2%)稳定,2例(1.6%)加重;根据McCormick脊髓神经功能分级,92例Ⅰ级,15例Ⅱ级,10例Ⅲ级,3例Ⅳ级。影像学检查显示硬脊膜囊复胀良好,未见复发病例。结论显微手术切除椎管内脊膜瘤安全有效,术后症状改善明显,并发症较少。Objective To investigate the effect of treatment of spinal meningioma with microsurgical procedures.Methods From January 2003 to March 2022,there were 120 patients who had spinal meningioma and treated in the Department of Neurosurgery,The First Affiliated Hospital of Sun Yat-sen University.Their clinical data were retrospectively analysed.Of the 120 patients,there were 90 females and 30 males,aged from 14 to 85(average,54)years old.According to McCormick Classification,29 cases were in grade I,59 cases were in grade II,25 cases were in grade III,and 7 cases were in grade IV.They were all underwent microsurgery.Patients were followed up by outpatient service within 3 months after surgery,then reviewed by outpatient visits and telephone interviews.McCormick's classification method and MRI examination were used to analyse the neurological and imaging changes of the patients before and after the surgery.Results A total of 113 patients had complete resection and 7 had the resection of most part of the spinal meningioma.No infection,cerebrospinal fluid leakage,other complications and death occurred.Three months after surgery,95 patients achieved the improvement or even completely disappearance of symptoms(such as numbness,pain,limited movement,etc.).There were 23 patients who had the symptoms unchanged as what before the surgery.Two patients had the symptoms worsened after the surgery.At 3 months after surgery,95 cases(79.2%)improved,23 cases(19.2%)were stable,and 2 cases(1.6%)aggravated.According to McCormick classification method,92 cases were in gradeⅠ,15 cases were in gradeⅡ,10 cases were in gradeⅢ,and 3 cases were in gradeⅣ.MRI scans showed that the dural sac were well refluxed,and no recurrence was found.Conclusion Microsurgery is safe and effective for removal of spinal meningioma,with significant improvement in symptoms with fewer complications.

关 键 词：椎管内肿瘤 脊膜瘤 显微手术 疗效 

分 类 号：R739.42[医药卫生—肿瘤]