神经内镜手术治疗症状性骶管囊肿的疗效分析  

Efficacy analysis of neuroendoscopic surgery for the treatment of symptomatic sacral Tarlov cysts

作　　者：张腾飞 陈荣彬 陈文 戴大伟 Zhang Tengfei;Chen Rongbin;Chen Wen;Dai Dawei(Department of Neurosurgery,the Second Affiliated Hospital of Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学第二附属医院神经外科,上海200003

出　　处：《中华神经外科杂志》2023年第3期249-254,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82201519)。

摘　　要：目的探讨神经内镜手术治疗症状性骶管囊肿的方法及临床疗效。方法回顾性分析2019年2月至2022年2月海军军医大学第二附属医院神经外科收治的32例症状性骶管囊肿患者的临床资料。所有患者均采用神经内镜手术行骶管囊肿漏口自体肌筋膜组织封堵及脂肪组织囊腔填塞;采用疼痛视觉模拟量表(VAS)评分评估患者术前、术后1 d、术后3个月的疼痛程度;通过腰骶部MRI检查评估骶管囊肿的变化程度;通过体格检查评估患者的皮肤感觉、下肢肌力、排便、排尿、性功能等神经功能障碍的恢复情况。结果32例患者的神经内镜手术均成功,无一例发生手术相关并发症。术前存在骶尾部和(或)下肢疼痛的31例患者中,27例(87.1%)术后疼痛明显缓解,术前、术后1 d、术后3个月的VAS评分分别为(5.59±1.48)分、(2.50±1.05)分、(1.94±0.80)分,差异具有统计学意义(F=206.33,P<0.001)。所有患者术后1个月内MRI复查显示囊腔内的脑脊液信号转变为脂肪信号;其中10例患者术后3个月MRI复查可见囊腔内脂肪组织部分被吸收。术后3个月随访显示,患者的皮肤感觉异常、排便功能障碍、排尿功能障碍及性功能障碍的改善比例分别为4/7、3/5、2/3、1/1;术前下肢肌力为Ⅳ级的7例患者中,术后2例肌力恢复至Ⅴ级。结论神经内镜手术治疗症状性骶管囊肿能明显改善患者的疼痛症状,促进神经功能恢复,手术创伤小、有效率高,具有较好的临床疗效。Objective To investigate the method and efficacy of neuroendoscopic surgery for the treatment of symptomatic sacral Tarlov cysts.Methods A retrospective review was performed on the clinical data of 32 patients with symptomatic sacral Tarlov cysts who were admitted to the Department of Neurosurgery,the Second Affiliated Hospital of Naval Military Medical University from February 2019 to February 2022.All patients underwent neuroendoscopic surgery.The inlet fistula was blocked by a small piece of myofascial tissue,and the cyst cavity was filled with autologous adipose tissue.The visual analog scale(VAS)was used to evaluate the pain level of the patients before surgery,1 day after surgery,and 3 months after surgery.The change of cystic cavity was evaluated by lumbrosacral MRI.The improvement of neurological dysfunction,including skin sensation,lower limb muscle strength,feces and urine,and sexual function,was evaluated by physical examination.Results The operations of 32 patients with symptomatic sacral Tarlov cysts were successful,and no operation-related complications occurred.Of the 31 patients with pre-operative sacrococcygeal and/or lower extremity pain,27(87.1%)had significant pain relief post operation.The VAS score prior to operation,at 1-d and 3-month follow-up was 5.59±1.48,2.50±1.05 and 1.94±0.80 respectively.The postoperative VAS score was significantly lower than that before surgery(F=206.33,P<0.001).All 32 patients underwent MRI reexamination within 1 month after surgery,and the results showed that cerebrospinal fluid signals in the cystic cavity had been converted into fat signals.The MRI reexamination at 3 months post operation showed that the fat in the cystic cavity had been partially absorbed in 10 patients.At the 3-month follow-up,the improvement rate of skin paresthesia,fecal and urinal dysfunction and sexual dysfunction was 4/7,3/5,2/3 and 1/1 respectively.Of the 7 patients whose muscle strength was gradeⅣbefore surgery,2 patients recovered to gradeⅤafter surgery.Conclusions The myofasci

关 键 词：骶管囊肿 自然腔道内镜手术 内填塞 治疗结果 

分 类 号：R651[医药卫生—外科学]