颈前入路切除突入胸廓上口臂丛神经鞘瘤的手术分析  

Surgical analysis of anterior cervical approache in the treatment of brachial plexus schwannoma of thoracic outlet

作　　者：董益鹏[1] 刘藏[1] 张晶[1] 张向华[1] Dong Yipeng;Liu Cang;Zhang Jing;Zhang Xianghua(Department of Neurosurgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院神经外科,北京100050

出　　处：《国际外科学杂志》2023年第11期752-756,F0004,共6页International Journal of Surgery

摘　　要：目的探讨经颈前入路切除从椎间孔区向前下方生长突入胸廓上口的臂丛神经鞘瘤的手术治疗策略,评估手术疗效。方法回顾性收集首都医科大学附属北京友谊医院2016年7月—2020年12月收治的8例采用颈前入路颈部锁骨上"倒钩型"切口切除突入胸廓上口的臂丛神经鞘瘤患者的临床资料,其中男性5例,女性3例,年龄(50.75±11.14)岁,年龄范围31~66岁。分析手术相关要点、术后并发症以及术后随访情况。正态分布的计量资料以均数±标准差(±s)表示,计数资料以例数表示。结果8例患者全部完整切除肿瘤,术中出血量为(35.00±14.14)mL,术后出现局部感觉障碍加重2例,经营养神经、激素治疗后症状消失。无胸膜损伤、气胸、血胸等并发症的发生。8例患者均通过门诊或电话获得随访,随访1~5年,复查颈椎核磁均提示肿瘤无原位复发。结论采用颈前入路颈部锁骨上"倒钩型"切口的方式切除突入胸廓上口的臂丛神经鞘瘤临床效果满意,术中损伤小、出血量少,术后恢复快。ObjectiveeTo investigate the surgical treatment strategies of brachial plexus schwannomas protruding from the foraminal area to the thoracic outlet through anterior cervical approach,and to evaluate the curative effect.Methods The clinical data of 8 patients treated in Beijing Friendship Hospital Affiliated to Capital Medical University from July 2016 to December 2020 who underwent supraclavicular cervical"barb"incision for protruding into the thoracic outlet through anterior cervical approach were retrospectively collected,including 5 males and 3 females,aged(50.75±11.14)years old,ranging from 31-66 years old.And the key points of the operation,postoperative complications and postoperative follow-up were analyzed.Measurement data with normal distribution were represented as mean±standard deviation(x+s),count data were described as numbers.Results The tumors in all 8 cases were totally resected.The amount of bleeding during operation was(35.00±14.14)mL.No surgical complications such injury of pleura,aspneumothorax and hemothorax,except 2 cases which developed local sensory disturbance that improved that after neurotrophic treatment and hormonotherapy.All 8 patients were followed up by outpatient or telephone for 1-5 years,and cervical MRI review showed no tumor recurrence in situ.Conclusions The anterior cervical approach with "barb type"incision above the neck clavicle is effective in excision of schwannomas protruding into the thoracic outlet,with less intraoperative injury,less blood loss,fast postoperativerecovery.

关 键 词：头颈部肿瘤 神经鞘瘤 显微外科手术 颈前入路 

分 类 号：R739.91[医药卫生—肿瘤]