胸腰段椎管硬膜外囊肿显微手术中尾端技术应用(附12例分析)  

Application of caudal technique in microsurgery for thoracolumbar epidural cyst(analysis of 12 cases)

作　　者：王林[1] 彭楠[1] 曾明慧 梅翠竹 何芳[3] WANG Lin;PENG Nan;ZENG Minghui;MEI Cuizhu;HE Fang(Department of Neurosurgery,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China;Department of Medical,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China;Department of Electrophysiology,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)神经外科,安徽合肥230001 [2]中国科学技术大学附属第一医院(安徽省立医院)医务处,安徽合肥230001 [3]中国科学技术大学附属第一医院(安徽省立医院)电生理科,安徽合肥230001

出　　处：《南京医科大学学报（自然科学版）》2024年第9期1246-1249,1256,共5页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:探究显微镜下胸腰段椎管内硬膜外脊膜囊肿(spinal extradural meningeal cysts,SEMC)瘘口修补结合囊肿尾端技术处理的疗效和临床应用的可推广性。方法:回顾经电生理监测显微手术胸腰段SEMC瘘口修补结合囊肿尾端技术(切除囊肿尾端囊袋、囊肿尾端与正常硬脊膜交界处微小切口贯通脑脊液后常规缝合)的12例患者资料,结合文献传统手术方法进行分析。结果:平均随访14个月期间影像学囊肿完全消失9例,大部分消失1例,椎间孔内侧残留囊肿2例,无1例存在硬膜囊受压表现,无复发病例。术前腰背痛和/或下肢痛11例,出院时疼痛缓解或消失,随访3个月后疼痛改变与出院时比较差异无统计学意义。患者下肢无力及排尿功能障碍逐渐恢复,术后未出现新的神经功能缺失。椎板棘突解剖复位良好、无椎管狭窄和畸形病例。结论:电生理监测显微手术胸腰段SEMC瘘口修补结合囊肿尾端技术可以有效解决活瓣问题,闭合囊肿,无明显并发症,临床可行。Objective:To explore the curative effect and clinical applicability of microsurgical repair of spinal extradural meningeal cysts(SEMC)fistulas combined with cyst tail end technique in the thoracolumbar spine.Methods:Data from 12 patients who underwent thoracolumbar SEMC fistula repair combined with the cyst tail end technique(removal of the cystic sac at the tail end of the cyst,followed by a small incision at the junction of the cyst tail end and the normal dura mater to connect with cerebrospinal fluid,and then routine suturing)under electrophysiological monitoring microsurgery were retrospectively reviewed,and analyzed in conjunction with traditional surgical methods from the literature.Results:During an average follow-up of 14 months,complete cyst disappearance was observed in 9 cases,partial disappearance in 1 case,and residual cysts in the intervertebral foramen in 2 cases.No cases exhibited dural sac compression,and there were no recurrences.Among the 11 patients who had preoperative lower back pain and/or lower extremity pain,pain was relieved or disappeared upon discharge,and no significant differences in pain were observed 3 months of follow-up compared to discharge.Paitents with lower limb weakness and dysuria showed gradual recovery,and no new neurological deficits were noted postoperatively.The anatomical reduction of lamina spinous processes was good,with no cases of spinal stenosis and deformity.Conclusion:Electrophysiological monitoring microsurgical thoracolumbar SEMC fistula repair combined with cyst tail end technique effectively solve the problem of living flap and close cyst,with no significant complications,demonstrating clinical feasibility.

关 键 词：胸腰段硬膜囊肿 囊肿尾端技术 椎板棘突复位 显微手术 疗效 

分 类 号：R651.2[医药卫生—外科学]