经皮通道联合显微镜下手术切除胸椎哑铃型神经鞘瘤  

Microsurgical treatment for thoracic dumbbell shaped schwannoma under percutaneous tubular retractor system

作　　者：薛亮 陈业煌 吴箭午 郑兆聪 魏梁锋 Liang Xue;Yehuang Chen;Jianwu Wu;Zhaocong Zheng;Liangfeng Wei(Department of Neurosurgery,Fuzong Clinical Medical College of Fujian Medical University(900th Hospital of PLA Joint Logistic Support Force),Fuzhou 350025,China)

机构地区：[1]福建医科大学福总临床医学院(解放军联勤保障部队第九〇〇医院)神经外科,福州350025

出　　处：《中华神经创伤外科电子杂志》2024年第6期340-344,共5页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

基　　金：福建省科技计划科技创新平台项目(2022Y2017)

摘　　要：目的探讨经皮通道联合显微镜下一期手术切除胸椎哑铃型神经鞘瘤的可行性和安全性。方法回顾性分析福建医科大学福总临床医学院神经外科自2017年6月至2022年12月采用经皮通道系统联合显微镜手术切除胸椎哑铃型神经鞘瘤的患者43例。观察并统计患者的术中出血量、手术时间、住院时间及术后并发症。采用McCormick分级法评估患者的脊髓功能改善情况。采用视觉模拟评分(VAS)评估患者的疼痛程度,对比患者术前术后的评分变化。结果43例患者均完全切除肿瘤,术后病理证实均为神经鞘瘤,术中出血(85.2±16.7)mL,手术时间80.0(68.0,90.0)min,住院天数为6.0(5.0,7.0)d。术中2例患者发生胸膜撕裂,即刻予以封堵,术后无气胸、肺炎发生。术后末次随访复查胸椎CT、MRI未见胸椎畸形及肿瘤复发;脊髓功能改善42例(97.7%),无改善1例(2.3%)。患者术前1 d、出院时及末次随访时的VAS评分比较,差异有统计学意义(P<0.05)。结论经皮通道系统联合显微镜可一期、安全切除胸椎哑铃型神经鞘瘤,并可减少术中出血和术后并发症,缩短住院时间,降低脊柱不稳定的发生率。Objective To investigate the feasibility and safety of one-stage surgical resection of thoracic dumbbell shaped schwannoma under percutaneous tubular retractor system and microscopy.Methods A retrospective analysis was conducted on 43 cases of thoracic dumbbell shaped schwannoma treated by a combination of percutaneous tubular retractor system and microscopy in Neurosurgery Department of Fuzong Clinical Medical College of Fujian Medical University from June 2017 to December 2022.The patient&apos;s intraoperative bleeding volume,surgical time,hospital stay,and postoperative complications were recorded.The McCormick grading system was used to evaluate the improvement of spinal cord function in patients.The visual analog scale(VAS)was used to assess the level of pain in patients and the changes in scores before and after surgery were compared.Results All 43 cases of tumors were completely removed,and postoperative pathology confirmed that they were all schwannomas.Intraoperative bleeding was(85.2±16.7)mL,and the surgical time was 80.0(68.0,90.0)min.The length of hospital stay was 6.0(5.0,7.0)d.Two cases of pleural tear occurred during surgery and were immediately occluded,and no pneumothorax or pneumonia occurred after surgery.The last follow-up after surgery showed no thoracic vertebral deformities or tumor recurrence on CT and MRI.Forty-two cases(97.7%)showed improvement in spinal cord function,while 1 case(2.3%)showed no improvement.There was a statistically significant difference in the VAS scores of patients before surgery,at discharge,and at the last follow-up(P<0.05).Conclusion Combination of percutaneous tubular retractor system and microscope can safely remove thoracic dumbbell shaped schwannoma in one stage,reducing intraoperative bleeding and postoperative complications,shortening hospital stay,and reducing the incidence of spinal instability.

关 键 词：哑铃型肿瘤 神经鞘瘤 胸椎 肋横关节 经皮通道系统 显微外科 

分 类 号：R739.4[医药卫生—肿瘤]