显微镜下经Wiltse入路治疗椎间孔区神经鞘瘤的疗效分析  

Analysis of the efficacy of microscopic surgery for neurinoma in the thoracolumbar intervertebral foraminal region via the Wiltse approach

作　　者：丁大领[1] 邱锴[1] 张风江[1] 余斌[1] 陈煜 李恩[1] 庞长河[1] Ding Daling;Qiu Kai;Zhang Fengjiang;Yu Bin;Chen Yu;Li En;Pang Changhe(Department of Neurosurgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院神经外科,河南郑州450052

出　　处：《中国微侵袭神经外科杂志》2024年第11期641-646,共6页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：河南省医学科技攻关计划项目(编号:202102310138)。

摘　　要：目的探讨经Wiltse入路与传统后正中入路对胸腰椎椎间孔区神经鞘瘤的手术疗效。方法回顾性分析57例胸腰椎椎间孔区神经鞘瘤患者的临床资料,根据手术方式不同分为Wiltse入路组(n=32)和后正中入路组(n=25),两组患者在性别、年龄、肿瘤部位等方面差异无统计学意义(均P>0.05)。比较两组患者的手术时间、术中出血量、手术切口长度、术后住院时间及术后并发症等,通过疼痛视觉模拟量表(visualanaloguescale,VAS)评分评估两组术前疼痛情况及术后疼痛缓解程度,并观察两组患者症状的恢复情况。结果两组患者手术均顺利完成,病理结果均为神经鞘瘤。Wiltse入路组手术时间、术中出血量及术后住院时间明显少于后正中入路组,两组差异具有统计学意义(均P<0.05)。与术前比较,Wiltse入路组术后第1个月和第3个月的VAS评分均有明显改善(均P<0.05)。术后第3个月VAS评分,Wiltse入路组明显低于后正中入路组,差异具有统计学意义(P=0.029)。定期随访复查MRI,肿瘤均无复发。结论与传统后正中入路比较,Wiltse入路具有手术时间短、术中出血少、术后恢复快、住院时间短以及保护关节突关节和韧带复合体等优点。采用Wiltse入路治疗胸腰椎椎间孔区神经鞘瘤具有良好临床疗效和明显手术优势。Objective To compare the surgical outcomes of the Wiltse approach and the traditional posterior median approach for the treatment of neurinomas in the thoracolumbar intervertebral foramen region.Methods The clinical data of 57 patients with neurinoma in the thoracolumbar intervertebral foramen region were analyzed retrospectively.The patients were divided into the Wiltse approach group(n=32)and the posterior median approach group(n=25)based on the surgical method.There were no significant differences between the two groups in terms of gender,age and tumor location(all P>0.05).The surgical duration,intraoperative blood loss,surgical incision length,postoperative hospital stay and postoperative complications were compared between the two groups.The preoperative pain level and postoperative pain relief were assessed using the Visual Analogue Scale(VAS),and the recovery status of symptoms in both groups was observed.Results All surgeries were successfully completed,and the pathological results were neurinomas.The Wiltse approach group had significantly shorter surgical duration,less intraoperative blood loss,and shorter postoperative hospital stay compared with the posterior median approach group,with statistically significant differences(all P<0.05).Compared with preoperative levels,the VAS scores in the Wiltse approach group improved significantly at both 1 month and 3 months postoperatively(both P<0.05).The VAS scores at 3 months postoperatively were significantly lower in the Wiltse approach group than in the posterior median approach group,with a statistically significant difference(P=0.029).Regular follow-up MRI examinations showed no recurrence of the tumor.Conclusions Compared with the traditional posterior median approach,the Wiltse approach offers advantages such as shorter surgical duration,less intraoperative blood loss,faster postoperative recovery,shorter hospital stay,and better preservation of the articular process joints and ligamentous complex.The Wiltse approach for the treatment of neurinomas in t

关 键 词：神经鞘瘤 椎间孔区 哑铃型肿瘤 Wiltse入路 

分 类 号：R730.264[医药卫生—肿瘤]