經(jīng)半椎板切除入路顯微操作摘除椎管內(nèi)髓外硬膜下腫瘤的手術(shù)方法及效果評價
發(fā)布時間：2018-12-13 04:31
【摘要】：目的：探討經(jīng)半椎板切除入路顯微操作摘除椎管內(nèi)髓外硬膜下腫瘤的手術(shù)方法，進(jìn)一步闡明其臨床效果。 方法：回顧分析本院2009年1月～2011年12月治療的16例髓外硬膜下腫瘤患者的臨床資料。其中，男性7例，女性9例；年齡34～72歲，平均年齡49歲。病史7月～3年，平均15.7個月。腫瘤位于頸段3例，胸段4例，胸腰段9例。所有病例均有不同程度的脊髓壓迫癥狀和體征。所有患者均行術(shù)前MRI檢查顯示椎管內(nèi)占位并且必須包括對腫瘤的脊髓節(jié)段的精確定位。16例患者均選取靜脈吸入復(fù)合麻醉,采用20mL注射器針頭作為標(biāo)記物插入目標(biāo)棘突以確認(rèn)節(jié)段，并且于C型臂透視下精確定位、減少創(chuàng)傷。安置顯微鏡進(jìn)行顯微操作，術(shù)中用雙極電凝確切止血。術(shù)后切口外加壓包扎,椎板外置負(fù)壓引流，逐層縫合切口。14例患者采用半椎板入路順利切除腫瘤；2例患者由于腫瘤體積較大且位于腹側(cè)，難以充分顯露，故改用全椎板切除入路順利切除腫瘤。通過患者術(shù)前和術(shù)后神經(jīng)功能恢復(fù)情況的Frankel分級評價半椎板入路的臨床效果。 結(jié)果：術(shù)中平均出血量為300mL (150～500mL)，手術(shù)時間140min (90～200min)。14例行半椎板入路平均出血量為275mL（150～350mL），2例行全椎板入路出血量分別為450mL和500mL（平均出血量為475mL）。腫瘤體積最大4cm×1.5cm×l.5cm，最小1.5cm×1.0cm×l.0cm。術(shù)后病理證實,神經(jīng)鞘瘤11例，脊膜瘤4例，神經(jīng)纖維瘤1例。其中，1例患者術(shù)后出現(xiàn)腦脊液漏，采取嚴(yán)密縫合、加壓包扎并頭低腳高位后愈合。本組16例患者術(shù)后均未出現(xiàn)切口感染、脊柱不穩(wěn)等并發(fā)癥，術(shù)后3d即可床上活動，5d即可佩戴腰圍下地活動。16例患者中，術(shù)前Frankel分級B級3例，術(shù)后提高為C級；術(shù)前C級5例，術(shù)后提高為D級；術(shù)前D級7例，術(shù)后提高為E級。神經(jīng)鞘瘤11例，，脊膜瘤4例，神經(jīng)纖維瘤l例。所有患者均得到隨訪（6～40個月，平均23.7個月）。16例患者均未見復(fù)發(fā)而且脊柱穩(wěn)定性良好，全部患者的疼痛及神經(jīng)功能恢復(fù)的情況均獲得改善。 結(jié)論：半椎板切除術(shù)治療髓外硬膜下腫瘤具有損傷較小、出血較少等優(yōu)點(diǎn)，并且可以最大限度地維持脊柱的穩(wěn)定性。對于髓外硬膜下且偏向一側(cè)的腫瘤是該術(shù)式的最佳適應(yīng)證。同時腫瘤的橫徑一般應(yīng)小于2cm，且腫瘤的跨度限于2個椎體水平內(nèi)，不宜過大。應(yīng)該嚴(yán)格掌握適應(yīng)證，在不加重脊髓損傷的基礎(chǔ)上盡可能徹底摘除腫瘤。不論采取何種術(shù)式，均應(yīng)以盡可能完全切除腫瘤為前提，而不應(yīng)以殘留腫瘤病灶為代價刻意追求微創(chuàng)術(shù)式。總體來說，經(jīng)半椎板切除入路摘除椎管內(nèi)髓外硬膜下腫瘤的手術(shù)效果令人滿意。
[Abstract]:Objective: to explore the microsurgical method for the removal of subdural intramedullary tumors in the spinal canal and to elucidate the clinical effect. Methods: the clinical data of 16 patients with subdural extramedullary tumors treated in our hospital from January 2009 to December 2011 were retrospectively analyzed. There were 7 males and 9 females, aged 3472 years with an average age of 49 years. The history ranged from July to 3 years, with an average of 15.7 months. The tumors were located in cervical segment in 3 cases, thoracic segment in 4 cases and thoracolumbar segment in 9 cases. All cases had different degree of spinal cord compression symptoms and signs. All patients underwent preoperative MRI examination to show intraspinal space occupation and must include accurate localization of the spinal cord segment of the tumor. 16 patients were selected for intravenous inhalation combined anesthesia. The 20mL syringe needle was used as marker to insert the target spinous process to confirm the segment and to locate accurately under the C-arm fluoroscopy to reduce the trauma. The microsurgery was performed with microscopes, and the bleeding was stopped by bipolar electrocoagulation. After operation, external compression bandage, negative pressure drainage of vertebral lamina and suture of incision were performed in 14 cases, and the tumor was resected successfully by semi-laminar approach. Because the tumor was large and located on the ventral side it was difficult to be fully exposed in 2 cases so the total laminectomy approach was used to remove the tumor successfully. The clinical effect of hemivertebra approach was evaluated by Frankel grading before and after operation. Results: the mean blood loss was 300mL (150~500mL), 140min (90~200min), 275mL (150~350mL) in 14 cases, 450mL and 500mL (475mL) in 2 cases. The tumor volume was the largest 4cm 脳 1.5cm 脳 l.5cm, and the smallest was 1.5cm 脳 1.0cm 脳 l.0cm. Postoperative pathology confirmed 11 cases of neurilemmoma, 4 cases of meningioma and 1 case of neurofibroma. One patient had cerebrospinal fluid leakage after operation, was sutured tightly, bandaged under pressure and healed after high head and low foot. There were no postoperative complications such as incision infection, spinal instability and so on. The patients could move on the bed 3 days after operation and wear the floor movement under the waist at 5 days. Among the 16 cases, 3 cases had Frankel grade B before operation, but it was improved to C grade after operation. Grade C was improved to grade D in 5 cases before operation and grade E to grade E in 7 cases of grade D before operation. There were 11 cases of neurilemmoma, 4 cases of meningioma and 1 case of neurofibroma. All the patients were followed up (6-40 months, mean 23.7 months). No recurrence and good spinal stability were found in 16 patients, and the pain and neurological function were improved in all patients. Conclusion: the treatment of subdural tumors with hemilaminectomy has the advantages of less injury and less bleeding, and can maintain the stability of the spine to the maximum extent. The best indication of this procedure is for subdural and unilateral tumors. At the same time, the transverse diameter of the tumor should be less than 2 cm, and the tumor span should be limited to 2 vertebrae levels, so it should not be too large. Indications should be strictly grasped and tumors should be removed as thoroughly as possible without exacerbating spinal cord injury. No matter what operation is adopted, the complete resection of the tumor should be the prerequisite, and the minimally invasive operation should not be pursued at the expense of residual tumor focus. In general, the results of subdural resection of intraspinal extramedullary tumors are satisfactory.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.4
[Abstract]:Objective: to explore the microsurgical method for the removal of subdural intramedullary tumors in the spinal canal and to elucidate the clinical effect. Methods: the clinical data of 16 patients with subdural extramedullary tumors treated in our hospital from January 2009 to December 2011 were retrospectively analyzed. There were 7 males and 9 females, aged 3472 years with an average age of 49 years. The history ranged from July to 3 years, with an average of 15.7 months. The tumors were located in cervical segment in 3 cases, thoracic segment in 4 cases and thoracolumbar segment in 9 cases. All cases had different degree of spinal cord compression symptoms and signs. All patients underwent preoperative MRI examination to show intraspinal space occupation and must include accurate localization of the spinal cord segment of the tumor. 16 patients were selected for intravenous inhalation combined anesthesia. The 20mL syringe needle was used as marker to insert the target spinous process to confirm the segment and to locate accurately under the C-arm fluoroscopy to reduce the trauma. The microsurgery was performed with microscopes, and the bleeding was stopped by bipolar electrocoagulation. After operation, external compression bandage, negative pressure drainage of vertebral lamina and suture of incision were performed in 14 cases, and the tumor was resected successfully by semi-laminar approach. Because the tumor was large and located on the ventral side it was difficult to be fully exposed in 2 cases so the total laminectomy approach was used to remove the tumor successfully. The clinical effect of hemivertebra approach was evaluated by Frankel grading before and after operation. Results: the mean blood loss was 300mL (150~500mL), 140min (90~200min), 275mL (150~350mL) in 14 cases, 450mL and 500mL (475mL) in 2 cases. The tumor volume was the largest 4cm 脳 1.5cm 脳 l.5cm, and the smallest was 1.5cm 脳 1.0cm 脳 l.0cm. Postoperative pathology confirmed 11 cases of neurilemmoma, 4 cases of meningioma and 1 case of neurofibroma. One patient had cerebrospinal fluid leakage after operation, was sutured tightly, bandaged under pressure and healed after high head and low foot. There were no postoperative complications such as incision infection, spinal instability and so on. The patients could move on the bed 3 days after operation and wear the floor movement under the waist at 5 days. Among the 16 cases, 3 cases had Frankel grade B before operation, but it was improved to C grade after operation. Grade C was improved to grade D in 5 cases before operation and grade E to grade E in 7 cases of grade D before operation. There were 11 cases of neurilemmoma, 4 cases of meningioma and 1 case of neurofibroma. All the patients were followed up (6-40 months, mean 23.7 months). No recurrence and good spinal stability were found in 16 patients, and the pain and neurological function were improved in all patients. Conclusion: the treatment of subdural tumors with hemilaminectomy has the advantages of less injury and less bleeding, and can maintain the stability of the spine to the maximum extent. The best indication of this procedure is for subdural and unilateral tumors. At the same time, the transverse diameter of the tumor should be less than 2 cm, and the tumor span should be limited to 2 vertebrae levels, so it should not be too large. Indications should be strictly grasped and tumors should be removed as thoroughly as possible without exacerbating spinal cord injury. No matter what operation is adopted, the complete resection of the tumor should be the prerequisite, and the minimally invasive operation should not be pursued at the expense of residual tumor focus. In general, the results of subdural resection of intraspinal extramedullary tumors are satisfactory.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.4
【參考文獻(xiàn)】
相關(guān)期刊論文 前3條
1 劉加貝;李忱;顧銳;高忠禮;王金成;;經(jīng)半椎板切除入路顯微操作摘除椎管內(nèi)髓外硬膜下腫瘤的手術(shù)方法及效果評價[J];吉林大學(xué)學(xué)報(醫(yī)學(xué)版);2013年05期
2 ;Unilateral hemilaminectomy for patients with intradural extramedullary tumors[J];Journal of Zhejiang University-Science B(Biomedicine & Biotechnology);2011年07期
3 劉加貝;顧銳;劉鵬;王U喕
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