脊髓髓内肿瘤显微手术治疗分析  

Clinical efficacy of microsurgical resection for patients with intramedullary spinal cord tumors(report of 35 cases)

作　　者：杨瑞鑫 李天栋 彭冲奇 邹宇辉 公方和 战俣飞 王国良 白红民 YANG Rui-xin;LI Tian-dong;PENG Chong-qi;Zou Yu-hui;GONG Fang-he;ZHAN Yu-fei;WANG Guo-liang;BAI Hong-min(Department of Neurosurgery,General Hospital of Southern Theater Command,Guangzhou 510010,China)

机构地区：[1]南部战区总医院神经外科,广州510010

出　　处：《中国临床神经外科杂志》2023年第12期693-695,700,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨脊髓髓内肿瘤的手术治疗方法及其疗效。方法回顾性分析2008年1月至2016年12月手术治疗的35例脊髓髓内肿瘤的临床资料。结果肿瘤全切除25例(71.4%),部分切除8例(22.9%),活检2例(5.7%)。术后病理示室管膜肿瘤14例,胶质瘤9例,血管母细胞瘤2例,表皮样囊肿3例,转移瘤3例,海绵状血管瘤2例,原发中枢神经系统淋巴瘤1例,副神经节瘤1例,囊肿1例。相比于胶质瘤(全切除率33.3%),室管膜瘤全切率(78.6%)相对较高(P<0.05)。术后发生感染1例(2.9%),无脑脊液伤口漏,无外固定松动或脱落,无手术死亡病例。术前McCormick分级Ⅰ级19例(54.3%),Ⅱ级8例(22.8%),Ⅲ级5例(14.3%),Ⅳ级3例(8.6%)。术后6个月,McCormick分级Ⅰ级15例(42.9%),Ⅱ级9例(25.7%),Ⅲ级6例(17.1%),Ⅳ级5例(14.3%)。手术前后McCormick分级无统计学差异(P>0.05)。术后6个月,McCormick分级改善6例(室管膜瘤2例,海绵状血管瘤1例,节细胞胶质瘤1例,血管母细胞瘤1例,转移性腺癌1例),无变化24例,恶化5例(均为胶质瘤)。结论MRI检查能早期诊断脊髓髓内肿瘤。显微手术切除肿瘤时,选择适当的固定方式,既可获得肿瘤的有效切除,又可达到保持脊柱稳定性的效果。Objective To investigate the surgical treatment of patients with intramedullary spinal cord tumors(ISCTs).Methods The clinical data of 35 patients with ISCTs who underwent mirosurgery from January 2008 to December 2016 were retrospectively analyzed.Results Total resection was performed in 25 patients(71.4%),partial resection in 8(22.9%)and biopsy in 2(5.7%).Postoperative pathological results showed ependymal tumors in 14 patients,gliomas in 9,hemangioblastoma in 2,epidermoid cyst in 3,metastatic tumors in 3,cavernous hemangiomas in 2,primary central nervous system lymphoma in 1,paraganglioma in 1,and cyst in 1.The total resection rate of ependymomas(78.6%)was significantly higher than that(33.3%)of gliomas(P<0.05).Postoperative infection occurred in 1 patient(2.9%).There was no cerebrospinal fluid wound leakage,external fixation loosening or loss,or surgical deaths.Nineteen patients(54.3%)were classified as McCormick gradeⅠ,8(22.8%)as gradeⅡ,5(14.3%)as gradeⅢ,and 3(8.6%)as gradeⅣbefore peration.Six months after surgery,McCormick gradeⅠwas achieved in 15 patients(42.9%),gradeⅡin 9(25.7%),gradeⅢin 6(17.1%),and gradeⅣin 5(14.3%).There was no significant difference in McCormick grades before and after surgery(P>0.05).Six months after surgery,McCormick grades were improved in 6 patients(2 ependymomas,1 cavernous hemangioma,1 gangliocytic gliomas,1 hemangioblastoma,and 1 metastatic adenocarcinoma),not significantly changed in 24,and worsened in 5 gliomas patients.Conclusions MRI is helpful to diagnose ISCTs early.When the patients with ISCTs undergoing microsurgery,the proper fixation method can not only obtain the effective resection of the tumors,but also maintain the stability of the spine.

关 键 词：脊髓髓内肿瘤 显微手术 疗效 

分 类 号：R739.42[医药卫生—肿瘤] R651.111[医药卫生—临床医学]