【摘要】：目的探討骶管囊腫的手術(shù)方式及療效。方法 2015年1月~2017年1月,顯微外科治療骶管囊腫43例,后正中切口行椎板切除或椎板切開(kāi)保留回置,顯微鏡下行囊腫漏口修補(bǔ)、神經(jīng)根松解、神經(jīng)根袖狀成形縫合或漏口縫扎、切斷外終絲,小囊腫在神經(jīng)電生理監(jiān)測(cè)下電凝塑形,明膠海綿、止血紗與人工硬脊膜材料或椎旁肌肌肉瓣填充骶管內(nèi)殘腔。結(jié)果行神經(jīng)根袖狀成形25例,其中合并小囊腫予以囊壁電凝塑形2例;囊腫漏口縫扎17例,其中9例行外終絲切斷;臀大肌肌皮瓣填充1例。椎板切除28例,椎板回置15例。手術(shù)時(shí)間82~300 min,中位數(shù)161 min,術(shù)中出血10~300 ml,中位數(shù)50 ml。隨訪6~27個(gè)月,中位時(shí)間15個(gè)月。與術(shù)前相比,末次隨訪時(shí)疼痛視覺(jué)模擬評(píng)分(VAS)顯著降低[中位數(shù)6分(0~10分)vs.0分(0~8分),Z=-5.230,P=0.000],JOA評(píng)分顯著升高[21分(4~28分)vs.28分(20~29分),Z=-5.314,P=0.000]。治愈19例(44.2%),顯效12例(27.9%),有效4例(9.3%),無(wú)效8例(18.6%),總有效率81.4%(35/43)。結(jié)論依據(jù)囊腫類型采取分類顯微外科手術(shù)治療骶管囊腫微創(chuàng)、安全,能夠明顯改善疼痛癥狀及神經(jīng)功能,囊腫漏口的處理和神經(jīng)根松解是治療的關(guān)鍵,應(yīng)早期治療以恢復(fù)骶管正常解剖學(xué)形態(tài)。
[Abstract]:Objective to investigate the operative method and curative effect of sacral cyst. Methods from January 2015 to January 2017, 43 cases of sacral canal cyst were treated by microsurgery. Laminectomy or laminectomy were performed in the posterior median incision, the leakage of cyst was repaired under microscope, and the nerve root was loosened. Nerve root cuff shaped suture or leakage suture, transection of outer end filaments, electrocoagulation of small cysts, gelatin sponge, hemostatic gauze and artificial dura mater or paravertebral muscle flap to fill sacral canal residual cavity. Results nerve root cuff formation was performed in 25 cases, of which 2 cases were complicated with small cyst, 17 cases were suture of cyst leakage, 9 cases were transection of outer end filaments, 1 case was filled with gluteus maximus myocutaneous flap. Laminectomy was performed in 28 cases and laminectomy in 15 cases. Operative time 82 min, median 161 min, intraoperative bleeding 10 ml, median 50 ml. The follow-up period was 6 to 27 months, with a median time of 15 months. Compared with before operation, the (VAS) score of pain visual analogue score decreased significantly [median 6 points (0 ~ 10) vs.0 score (0 ~ 8 points)] JOA score increased significantly [21 (4 ~ 28) vs.28 score (20 ~ 29) scores) and 5. 314P 0. 000] at the last follow-up, the pain visual analogue score (VAS) was significantly lower than that before operation [median 6 points (0 ~ 10) vs.0 scores (0 ~ 8 points)] and significantly increased [21 (4 ~ 28) vs.28 scores (20 ~ 29) scores]. 19 cases (44.2%) were cured, 12 cases (27.9%) were effective, 4 cases (9.3%) were effective, 8 cases (18.6%) were ineffective, the total effective rate was 81.4% (35 / 43). Conclusion it is safe and safe to treat sacral canal cyst by classified microsurgery according to the type of cyst. The treatment of cyst leakage and nerve root release is the key to the treatment. Early treatment should be used to restore the normal anatomy of the sacral canal.
【作者單位】： 北京大學(xué)第三醫(yī)院神經(jīng)外科;
【基金】：北京大學(xué)第三醫(yī)院2014年院重點(diǎn)項(xiàng)目基金(bysy201304)
【分類號(hào)】：R651.2

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