神经内镜治疗椎管内占位性病变12例

发布时间：2018-04-22 03:26

本文选题：神经内镜 + 脊髓外科　；参考：《中国微创外科杂志》2017年06期

【摘要】：目的探讨神经内镜在椎管内占位性病变中的应用。方法 2015年1月~2016年3月对椎管内占位性病变12例,全麻下行显微镜下后正中入路选择性椎板切除或半椎板切除,导入神经内镜,在神经内镜下多角度探查切除椎管内占位性病变。结果手术时间109~316 min,中位数136 min;术中出血量50~200 ml,中位数50 ml。12例椎管内占位内镜下病变全切,症状缓解。术后病理:神经鞘瘤6例,软骨样组织4例,畸胎瘤2例。术后JOA评分中位数28.5分(17~29分),显著高于术前中位数21.5分(5~27分)(Z=-2.936,P=0.003);治愈7例,显效5例。12例随访11~24个月,平均16.5月,未见肿瘤和间盘突出复发及脊柱不稳事件发生,无术后感染及新增神经损伤症状。结论神经内镜可以近距离多角度观察、定位椎管内病变,避免术中操作的盲目性,直视下进行操作对于病变的切除有指导意义,与显微镜联合应用可降低患者损伤。
[Abstract]:Objective to explore the application of neuroendoscopy in intraspinal space occupying lesions. Methods from January 2015 to March 2016, 12 cases of space-occupying lesions in the spinal canal were treated with selective laminectomy or hemilaminectomy under general anesthesia under the microscope. Endoscopic multi-angle exploration was performed for the removal of space occupying lesions in the spinal canal. Results the operative time was 109 ~ 316 mins (median 136 mins), the intraoperative bleeding volume was 50 ~ 200ml, and the median was 50 ml.12. Postoperative pathology: neurilemmoma in 6 cases, chondroid tissue in 4 cases, teratoma in 2 cases. The median JOA score of 17 ~ 29 points was significantly higher than that of preoperative median of 21.5 points, 5 ~ 27 points, and 7 cases were cured, 5 cases were followed up for 11 ~ 24 months, 12 cases were followed up for 11 ~ 24 months (mean, 16.5 months), there was no recurrence of tumor and disc herniation and spinal instability. No symptoms of postoperative infection and new nerve injury were found. Conclusion Endoscopy can be used to observe the lesions in the spinal canal at close range and from many angles, and to avoid the blindness of intraoperative operation. The operation under direct vision is of guiding significance for the resection of the lesions, and the combined application with microscope can reduce the injury of the patients.
【作者单位】：北京大学第三医院神经外科;
【基金】：北京大学第三医院2014年院重点项目基金(项目编号:bysy201304)
【分类号】：R739.4

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