一期手术结合脊柱内固定术治疗椎管内外沟通性哑铃型肿瘤

发布时间：2018-03-01 05:13

本文关键词： 显微外科手术椎管内外沟通性肿瘤脊柱内固定技术　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨一期手术结合脊柱内固定技术全切椎管内外沟通性哑铃型肿瘤的临床方法及疗效。方法:回顾性分析2014年11月至2015年11月我院显微镜下一期手术结合脊柱内固定技术治疗12例椎管内外沟通性肿瘤患者的临床资料。切除肿瘤后同时行脊柱内固定手术10例,均采用经椎弓根后路脊柱内固定技术。结果:手术全切9例,近全切2例,1例因术中出血过多终止手术。术后病理报告:神经鞘瘤8例,神经纤维瘤1例,恶性周围神经鞘膜瘤1例,恶性间皮瘤1例,高分化血管肉瘤1例。术后15天术前神经功能改善11例,无明显变化1例,无加重、手术感染、瘫痪及死亡病例。术后随访18到30月,平均25个月,其中8例良性肿瘤患者均恢复正常工作,生活。无加重及复发病例。3例恶性肿瘤患者其中1例恢复正常生活,1例症状较术前深浅感觉恢复,肌力同术前。1例患者因术中出血丰富被迫终止手术,未行脊椎重建及脊柱内固定技术,术后一月因颈部活动过大颈椎响动后死亡。结论:显微镜下经后路一期手术可全切椎管内外沟通性哑铃型肿瘤,为维持术后脊柱稳定性,需同时行相应椎体重和脊柱内固定技术。
[Abstract]:Objective: to investigate the clinical method and curative effect of one-stage operation combined with spinal internal fixation in the treatment of dumbbell-shaped tumors with internal and external communication in the spinal canal. Methods: from November 2014 to November 2015, we retrospectively analyzed the combined operation under the microscope in our hospital. Clinical data of 12 patients with spinal canal internal and external communication tumor treated by spinal internal fixation. Results: 9 cases underwent total resection and 1 case closed due to excessive intraoperative hemorrhage. Postoperative pathological report: 8 cases of neurilemmoma, 1 case of neurofibroma, 1 case of neurofibroma, 9 cases of spinal internal fixation via posterior pedicle of vertebrae, 9 cases of total operation and 1 case of nearly total resection of spinal cord due to excessive intraoperative hemorrhage. There were 1 case of malignant peripheral nerve sheath tumor, 1 case of malignant mesothelioma and 1 case of well-differentiated angiosarcoma. Patients with paralysis and death were followed up for 18 to 30 months, with an average of 25 months. Among them, 8 patients with benign tumors returned to normal work. Life. Among the 3 cases of malignant tumor without exacerbation and recurrence, 1 case returned to normal life and 1 case had the recovery of deep and shallow feeling than before, and the muscle strength was similar to that of 1 case before operation because of the abundant bleeding during the operation. No spinal reconstruction and spinal internal fixation were performed. In January, the patients died because of excessive cervical movement. Conclusion: the spinal canal and internal and external communication dumbbell tumors can be completely removed by one stage operation through the posterior approach under microscope, so as to maintain the stability of the spinal column after operation. The corresponding vertebral weight and spinal internal fixation should be performed at the same time.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.42

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