發(fā)布時(shí)間：2019-03-13 21:59

【摘要】：目的:探討椎管內(nèi)神經(jīng)鞘瘤的臨床表現(xiàn)、影像學(xué)特點(diǎn)以及半椎板顯微手術(shù)入路在治療椎管內(nèi)神經(jīng)鞘瘤中的臨床應(yīng)用。方法:對廣西醫(yī)科大學(xué)第一附屬醫(yī)院及第二附屬醫(yī)院神經(jīng)外科2015年1月—2015年12月收治且術(shù)后病理確診為椎管內(nèi)神經(jīng)鞘瘤25例經(jīng)半椎板顯微入路手術(shù)患者的臨床資料進(jìn)行回顧性分析,并對手術(shù)時(shí)間、術(shù)中出血量、腫瘤全切率、住院時(shí)間,術(shù)后有無腦脊液漏、各節(jié)段椎體術(shù)前術(shù)后JOA評分和VAS評分,術(shù)后隨訪情況等資料進(jìn)行研究,并結(jié)合文獻(xiàn)復(fù)習(xí),進(jìn)行總結(jié)。結(jié)果:25例椎管內(nèi)神經(jīng)鞘瘤患者,其中男性患者14例,女性患者11例,年齡12-62歲,平均40.80±13.79歲,手術(shù)時(shí)間60-480min,平均(234.64±91.93)min,出血量50-600ml,平均(300.00±126.66)ml,住院天數(shù)13—34天,平均(21.28±5.26)天。大部分首發(fā)癥狀為根性疼痛,隨病情進(jìn)展,出現(xiàn)一側(cè)或雙側(cè)膚體乏力或麻木或淺感覺減退11例,出現(xiàn)一側(cè)或雙側(cè)膚體疼痛6例,出現(xiàn)腰痛癥狀4例,出現(xiàn)四肢乏力或麻木或淺感覺減退3例,出現(xiàn)括約肌障礙1例。所有患者均行MRI且能較好的顯示病灶。25例患者均接受了半椎板顯微手術(shù)入路外科手術(shù)治療,全切率100%,術(shù)后病理證實(shí)為神經(jīng)鞘瘤。術(shù)后未發(fā)生腦脊液漏。頸椎術(shù)前JOA評分8.875±1.4577,頸椎術(shù)后JOA評分14.375±1.479,兩者差異具有統(tǒng)計(jì)學(xué)意義(t=-29.103,P=0.000)。胸椎術(shù)前JOA評分5.208±0.6201,胸椎術(shù)后JOA評分8.875±0.6077,兩者差異具有統(tǒng)計(jì)學(xué)意義(t=-19.501,P=0.000)。腰椎術(shù)前JOA評分12.800±3.5637,腰椎術(shù)后JOA評分23.400±2.7019,兩者差異具有統(tǒng)計(jì)學(xué)意義(t=-9.842,P=0.001)。椎管內(nèi)神經(jīng)鞘瘤術(shù)前JOA評分6.56±0.712,頸椎術(shù)后JOA評分1.72±0.678,兩者差異具有統(tǒng)計(jì)學(xué)意義(t=32.435,P=0.000)。術(shù)后癥狀較術(shù)前有明顯改善,術(shù)后隨訪6—12個(gè)月均未發(fā)現(xiàn)腫瘤復(fù)發(fā),未發(fā)現(xiàn)脊柱不穩(wěn)定及畸形。結(jié)論:椎管內(nèi)神經(jīng)鞘瘤MRI表現(xiàn)具有特征性,有助于診斷,并對進(jìn)一步治療有指導(dǎo)意義。半椎板顯微手術(shù)切除椎管內(nèi)神經(jīng)鞘瘤具有創(chuàng)傷小,恢復(fù)快,能最大限度的維持脊柱穩(wěn)定性等優(yōu)點(diǎn),取得較好療效,是一種安全有效手術(shù)方式,值得臨床推廣。但是由于暴露范圍的限制,采用半椎板顯微手術(shù)切除椎管內(nèi)腫瘤要掌握其適應(yīng)癥,選擇合適的病例,對椎管內(nèi)巨大腫瘤和多發(fā)腫瘤應(yīng)慎重選擇。
[Abstract]:Objective: to investigate the clinical manifestations, imaging features and clinical application of semilaminar microsurgical approach in the treatment of intraspinal neurilemmoma. Methods: from January 2015 to December 2015 in neurosurgery department of the first affiliated Hospital and the second affiliated Hospital of Guangxi Medical University, 25 patients with intraspinal neurilemmoma were pathologically diagnosed as intraspinal neurilemmoma by semi-laminar microsurgical approach. The data were analyzed retrospectively. The data of operation time, intraoperative blood loss, tumor total resection rate, hospitalization time, cerebrospinal fluid leakage after operation, JOA score, VAS score and follow-up of each segment of vertebral body before and after operation were studied, and the literature review was carried out to summarize the data of operation time, volume of blood loss during operation, total resection rate of tumor, length of hospitalization, cerebrospinal fluid leakage after operation. Results: twenty-five patients with intraspinal neurilemmoma, including 14 male patients and 11 female patients, were 12 years old with an average age of 40.80 鹵13.79 years. The operative time was 60? 480min and the average bleeding volume was (234.64 鹵91.93) min, 50? 600ml. The average hospital stay was (300.00 鹵126.66) ml, for 34 days and (21.28 鹵5.26) days, respectively. Most of the initial symptoms were root pain. With the progression of the disease, 11 cases had one or both sides of the skin weakness or numbness or shallow sensation decline, 6 cases of one or both skin pain, 4 cases of low back pain. There were 3 cases of limb weakness or numbness or superficial hyposensory and 1 case of sphincter dysfunction. All patients were treated with MRI and the lesions were well demonstrated. 25 patients were treated by semilaminar microsurgical approach, with a total resection rate of 100%. Postoperative pathology confirmed neurilemmoma. No cerebrospinal fluid leakage occurred after operation. The preoperative JOA score was 8.875 鹵1.4577, and the postoperative JOA score was 14.375 鹵1.479. The difference was statistically significant (t = 29.103, P < 0.000). The preoperative JOA score was 5.208 鹵0.6201, and the post-thoracic JOA score was 8.875 鹵0.6077. There was a significant difference between the two groups (t = 19.501, P < 0.001). The preoperative JOA score was 12.800 鹵3.5637, and the post-operative JOA score was 23.400 鹵2.7019. The difference was statistically significant (t = 9.842, P < 0.001). The preoperative JOA score of intraspinal neurinoma was 6.56 鹵0.712, and the JOA score of postoperative cervical spine was 1.72 鹵0.678. The difference was statistically significant (t = 32.435, P < 0.001). After 6 months follow-up, no recurrence of the tumor was found, and no instability or deformity of the spine was found. Conclusion: the MRI features of intraspinal neurilemmoma are characteristic and helpful for diagnosis and treatment of spinal neurilemmoma. Microsurgical resection of intraspinal neurilemmoma with semi-laminae has the advantages of less trauma, faster recovery, maximum stability of spinal column, and good curative effect. It is a safe and effective way of operation and is worthy of clinical popularization. However, due to the limitation of exposure range, microsurgical resection of intraspinal tumors by semi-laminar microsurgery should grasp the indications, select appropriate cases, and carefully select giant tumors and multiple tumors in the spinal canal.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.42

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