三维体层重建技术在胸腰段椎管哑铃型肿瘤手术中的应用  

Clinical application of three dimensional tomographic reconstruction technology in surgery of thoracic and lumbar dumbbell tumors

作　　者：唐志坚 吴雅奇 周军 刘胜文 王煜 舒凯[1] 雷霆[1] Tang Zhijian;Wu Yaqi;Zhou Jun;Liu Shengwen;Wang Yu;Shu Kai;Lei Ting(Department of Neurosurgery,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《中华神经外科杂志》2023年第4期362-367,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81901895)。

摘　　要：目的探讨三维体层重建技术在胸腰段椎管哑铃型肿瘤手术中的应用价值。方法回顾性分析2017年1月至2021年12月华中科技大学同济医学院附属同济医院神经外科收治的24例胸腰段椎管哑铃型肿瘤患者的临床资料。所有患者术前均行胸腰椎CT增强和MRI检查,并将CT影像数据导入医学影像三维重建系统进行三维重建,根据重建结果制定手术计划后行手术切除肿瘤。术后1周、3个月复查CT及MRI评估手术疗效。门诊随访患者的症状缓解情况,并采用McCormick分级评估神经功能,以视觉模拟评分(VAS)评价患者的疼痛感受。结果所有患者(100.0%)均一期全切除肿瘤。手术时间为(140±48)min(80~215 min),术中失血量为(270±120)ml(50~600 ml)。术后住院时长为(7.5±2.1)d(4~11 d)。术后病理学结果提示:神经鞘瘤19例,神经节细胞瘤2例,神经纤维瘤2例,原始神经外胚层肿瘤1例。术后2例(8.3%)患者并发气胸,1例(4.2%)发生脑脊液漏及伤口感染,无死亡病例。24例均获得随访,随访时间为(15.2±6.5)个月(3~40个月)。所有患者的症状均有不同程度的缓解。至末次随访,24例患者的VAS由术前的(3.0±2.0)分下降至(1.1±1.0)分(t=4.05,P=0.001),McCormick分级较术前改善(Z=-4.60,P<0.001)。术后3个月未见肿瘤复发。随访期间无一例发生脊柱失稳。结论应用三维体层可视化重建技术帮助制定胸腰段椎管哑铃型肿瘤手术方案,有利于肿瘤的完全切除,改善患者的预后。Objective To evaluate the application value of preoperative three dimensional(3D)tomographic reconstruction technology in surgery of thoracic and lumbar dumbbell-shaped tumors.Methods The clinical data of 24 patients with thoracic or lumbar dumbbell-shaped tumors admitted to the Department of Neurosurgery,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology from January 2017 to December 2021 were analyzed retrospectively.Besides MRI examination,enhanced CT scanning of thoracic or lumbar spine was performed for all patients and the primary imaging data were input into a commercially available 3D medical imaging reconstruction system for 3D reconstruction.Based on the stereoscopic images,surgical plans were determined for guiding tumor resection.To evaluate the efficacy of surgery,CT and MRI examination were performed one week and three months after surgery.Outpatient follow-up was applied to assess symptom relief.Neurological function was evaluated by using McCormick scale,and pain perception was assessed based on the visual analogue scale(VAS).Results All tumors(100.0%)were completely removed in one-stage operation,with a mean operation time of 140±48 min(range:80-215 min)and a mean blood loss of 270±120 ml(range:50-600 ml).The hospital stay was 4-11 days(mean:7.5±2.1 days).Pathological results revealed 19 cases of schwannoma,2 cases of gangliocytoma,2 cases of neurofibroma and 1 case of neuroectodermal tumor.All patients showed different degrees of relief of preoperative symptoms.Postoperative complications occurred in 3 cases,including 2 cases(8.3%)of pneumothorax,1 case(4.2%)of cerebrospinal fluid leakage and wound infection,and no death cases.All 24 patients were followed up for 3-40 months(mean:15.2±6.5 months).At the last follow-up,the VAS score of 24 patients decreased from 3.0±2.0 points to 1.1±1.0 points after surgery(t=4.05,P=0.001).The patients′McCormick grades improved compared with preoperative grades(Z=-4.60,P<0.001).During the follow-up,no spinal instabili

关 键 词：脊椎肿瘤 显微外科手术 治疗结果 三维体层重建技术 哑铃型肿瘤 

分 类 号：R739.42[医药卫生—肿瘤]