椎管内外沟通瘤的诊治分析(附19例报道)  

Diagnosis and treatment of patients with spinal dumbbell tumors:report of 19 cases and literature review

作　　者：徐欣 张国臣 康建磊 王莹 韩磊 陈忠平[2] XU Xin;ZHANG Guo-chen;KANG Jian-lei;WANG Ying;HAN Lei;CHEN Zhong-ping(Department of Neurosurgery,The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital,Zhengzhou 450008,China;Department of Neurosurgery/Neuro-oncology,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)神经外科,郑州450008 [2]中山大学肿瘤防治中心神经外科/神经肿瘤科,广州510060

出　　处：《中国临床神经外科杂志》2023年第8期481-483,共3页Chinese Journal of Clinical Neurosurgery

基　　金：河南省医学科技攻关计划(联合共建)(LHGJ20190655)。

摘　　要：目的探讨椎管内外沟通瘤的临床特征、手术方法及其效果。方法回顾性分析2014年1月至2022年12月手术治疗的19例椎管内外沟通瘤的临床资料。结果肿瘤位于颈段椎管13例,胸段椎管4例,腰段椎管2例。13例采用后正中入路,3例采用距离肿瘤最近处入路,3例采用联合入路。肿瘤全切除14例,次全切除4例,部分切除1例。术后无脑脊液漏、感染。术后病理显示神经鞘瘤13例,脊膜瘤2例,神经纤维瘤2例,恶性外周神经鞘瘤1例,孤立性纤维性肿瘤1例。术后随访6个月~9年,1例恶性外周神经鞘瘤术后1年死于肿瘤复发引起的恶病质;其余18例无肿瘤复发,也无脊柱侧弯、畸形等并发症。结论椎管内外沟通瘤临床较少见,一旦发现,应尽早手术切除,效果良好。手术入路要结合肿瘤节段、突出椎管的位置、肿瘤大小等多因素考虑,必要时需联合胸外科或泌尿外科共同手术。Objective To investigate the clinical features,surgical methods and outcomes of patients with spinal dumbbell tumors.Methods The clinical data of 19 patients with spinal dumbbell tumors who underwent surgery from January 2014 to December 2022 were retrospectively analyzed.Results The tumors of 13 patients were located in cervical spinal canal,4 in thoracic spinal canal and 2 in lumbar spinal canal.The posterior median approach was used in 13 patients,the nearest approach to the tumor was used in 3 patients,and the combined approach was used in 3 patients.Total resection of the tumors was achieved in 14 patients,subtotal in 4 patients,and partial in 1 patient.There was no cerebrospinal fluid leakage or infection after the operation.Postoperative pathological results showed schwannoma in 13 patients,meningioma in 2,neurofibroma in 2,malignant peripheral schwannoma in 1 and solitary fibrous tumor in 1.The follow up ranged from 6 months to 9 years.One patient with malignant peripheral schwannoma died of cachexia caused by tumor recurrence 1 year after the surgery,and the other patients had no recurrence or complications.Conclusions Spinal dumbbell tumors are rare in clinic.Once the tumors are found in patients,surgeries are recommanded as soon as possible and the surgical outcomes are good.The surgical approach should be selected according to tumor segment,location of protruding spinal canal,and tumor size.If necessary,it should be combined with thoracic surgery or urology surgery.

关 键 词：椎管内外沟通瘤 临床特征 显微手术 疗效 

分 类 号：R739.42[医药卫生—肿瘤] R651.11[医药卫生—临床医学]