经皮微通道显微镜下手术切除腰椎管内髓外硬膜下肿瘤的疗效  

Efficacy of microsurgery though percutaneous microchannel for patients with intradural extramedullary tumors in the lumbar spinal canal

作　　者：康正文 饶显峰 陈剑威 王波[1] 汪童 张秋生[1] KANG Zheng-wen;RAO Xian-feng;CHEN Jian-wei;WANG Bo;WANG Tong;ZHANG Qiu-sheng(Department of Neurosurgery,The Second People's Hospital of Shenzhen,Shenzhen 518025,China)

机构地区：[1]深圳市第二人民医院神经外科,广东518025

出　　处：《中国临床神经外科杂志》2023年第9期577-580,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨经皮微通道显微镜下手术切除腰椎管内髓外硬膜下肿瘤的疗效。方法回顾性分析2016年1月至2022年9月经皮微通道显微镜下手术切除的21例腰椎管内髓外硬膜下肿瘤的临床资料。结果21例肿瘤均完整切除,术后病理显示神经鞘瘤16例,室管膜瘤5例。术后无神经功能障碍加重、切口感染及脑脊液漏。手术时间76~345 min,平均(164.76±57.07)min;术中出血量10~100 ml,中位数20 ml(20~45 ml);术后下床活动时间1~6 d,中位数2 d(1~4 d);术后住院时间3~13 d,平均(6.19±3.20)d。18例术前神经支配区疼痛或麻木、7例下肢运动障碍、2例大小便功能障碍在术后均基本恢复。术后CT三维重建显示椎板小块缺损,未发现腰椎不稳和畸形。术1周([3.24±0.62)分]、术后3个月([1.90±0.70)分]、术后6个月([0.95±0.67)分]VAS评分较术前([5.38±0.86)分]明显降低(P<0.001),术1周([19.67±1.98)分]、术后3个月([23.71±1.42)分]、术后6个月([27.14±1.11)分]JOA评分较术前([13.76±0.94)分]明显增高(P<0.001)。结论经皮微通道显微镜下手术切除腰椎管内髓外硬膜下肿瘤是一种安全、有效的方法,能最大限度地保护椎体及椎旁正常的解剖结构,有效稳定脊柱,同时减轻手术创伤。Objective To evaluate the efficacy of microsurgical resection through percutaneous microchannel for patients with intradural extramedullary tumors in the lumbar spinal canal.Methods The clinical data of 21 patients with intradural extramedullary tumors in the lumbar spinal canal who underwent microsurgical resection through percutaneous microchannel from January 2016 to September 2022 were analyzed retrospectively.Results Total rsection of the tumors was achieved in all patients.The postoperative pathological results showed neurilemmoma in 16 patients and ependymoma in 5.There were no worsening of neurological dysfunction,incision infection and cerebrospinal fluid leakage after operation.The operative time was 76~345 min,with an average of(164.76±57.07)min.Intraoperative blood loss ranged from 10 ml to 100 ml,with a median of 20 ml(20~45 ml).The time of getting out of bed after surgery was 1~6 days,with a median time of 2 days(1~4 days).Postoperative hospital stay was 3~13 days,with an average of(6.19±3.20)days.Innervation pain or numbness in 18 patients,lower limb movement disorder in 7 patients and defecation dysfunction in 2 patients were recovered after operation.Postoperative CT after 3D reconstruction showed small laminar defects without lumbar instability or deformity.The VAS scores at 1 week[(3.24±0.62)points],3 months[(1.90±0.70)points]and 6 months after surgery[(0.95±0.67)points]were significantly lower than that[(5.38±0.86)points]before surgery(P<0.001).The JOA score at 1 week[(19.67±1.98)points],3 months[(23.71±1.42)points]and 6 months after surgery[(27.14±1.11)points]was significantly higher than that[(13.76±0.94)points]before surgery(P<0.001).Conclusions Microsurgical resection through percutaneous microchannel is a safe and effective method for patients with intradural extramedullary tumors in the lumbar spinal canal,which can protect the normal anatomy of the vertebral body and paravertebral structure to the maximum extent and effectively stabilize the spine,and reduce surgical trauma.

关 键 词：椎管内肿瘤 髓外硬膜下肿瘤 经皮微通道 微创手术 疗效 

分 类 号：R739.42[医药卫生—肿瘤]