经后路显微手术切除胸椎神经根束膜囊肿1例  

Microsurgery via posterior approach for a case of multiple neuroradicular cysts at the thoracolumbar spine

作　　者：杨晓勇[1] 刘小波[1] 廖进 张勇[1] 周杰 魏厚禄[1] 邓磊 YANG Xiao-yong;LIU Xiao-bo;LIAO Jin;ZHANG Yong;ZHOU Jie;WEI Hou-lu;DENG Lei(Department of Neurosurgery,Suining First People's Hospital,Suining 629000,China)

机构地区：[1]遂宁市第一人民医院神经外科,四川629000

出　　处：《中国临床神经外科杂志》2024年第3期190-192,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：神经根束膜囊肿发病率不高,多数学者认为其形成原因与先天发育异常、创伤等因素有关,其形成机制以“球阀机制”学说较为合理。多数神经根束膜囊肿无临床症状,无需特殊处理;少数伴有临床症状者,建议手术治疗,但手术方式仍存在争议。本文报道1例59岁女性,因检查发现胸腰椎多发囊肿2年、左侧卧位时右侧腹部疼痛不适1年余入院,视觉模拟量表(VAS)评分4分,胸腰椎增强MRI检查示胸10/11双侧、胸12/腰1右侧椎间孔区多发无确切强化囊性病灶。病人存在大小不等、位置不同的4个囊肿,仅右侧胸10/11椎间孔区处的较大囊肿在左侧卧位时才出现神经根压迫症状,其余三个囊肿均未引起临床症状。完善术前准备后,在全麻下行右侧胸10/11囊肿囊壁部分切除+神经根袖套成形+自体脂肪-肌肉-蛋白胶囊肿填塞术治疗,术后6 h右侧腹部疼痛消失,术后3个月电话随访,无右侧腹痛,未再行影像学复查。这提示对于有症状的胸腰椎神经根束膜囊肿,行神经根束膜囊壁部分切除+自体脂肪-肌肉-纤维蛋白胶囊肿填塞术治疗可取得满意效果。Neuroradicular cysts are not common,and their formation is related to congenital developmental anomalies and trauma,and the"ball valve mechanism"theory is a reasonable mechanism for their formation.Most neuroradicular cysts have no clinical symptoms and do not require treatment.For those with clinical symptoms,surgery is recommended,but there is still controversy over the surgical method.This report describes a 59-year-old female who presented with multiple cysts at the thoracolumbar spine and right lower abdominal pain for over a year when in the left lateral position,with a visual analogue scale(VAS)score of 4.Thoracolumbar enhanced MRI showed multiple non-specifically enhanced cystic lesions at the bilateral T10/11 and right T12/L1 foramen.The patient had four cysts of varying sizes and locations,with the larger cyst in the right T10/11 intervertebral foramen causing symptoms of nerve root compression when the patient was in the left lateral position.The other three cysts did not cause any clinical symptoms.After completing preoperative preparations,the patient underwent a surgical treatment under general anesthesia,including partial resection of the cyst wall in the 10/11 intervertebral foramen on the right side,nerve root sleeve formation,and autologous fat-muscle-protein gel cyst filling.The patient's right lower abdominal pain disappeared 6 hours after the surgery,and a telephone follow-up 3 months after the surgery revealed no recurrence of right lower abdominal pain.This suggests that for neuroradicular cysts with symptoms,partial resection of the cyst wall and autologous fat-muscle-protein gel cyst filling can achieve satisfactory outcomes.

关 键 词：胸椎神经根束膜囊肿 显微手术 经后路手术 疗效 

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