使用自制的无损伤撑开器及剥离器治疗脊髓腹侧肿瘤

发布时间：2018-05-22 14:27

本文选题：无张力 + 撑开器　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:评价一种自行制作的无张力撑开器及剥离器在脊髓腹侧肿瘤显微手术中的应用的安全性和有效。方法:在13例脊髓腹侧肿瘤患者的显微切除手术过程中使用自行制作的无张力撑开器及剥离器,并回顾性分析12例常规使用金属神经剥离器及棉片的病例,对比手术的效果及恢复情况。制作方法:制作无张力撑开器:使用腰穿脑脊液测压管一根并将其下端减去使之成为一根直的测压管,并将其剪去一端使之成为22cm长;剪裁一个一次性输液器,选取输液管和漏斗备用。使用6号手术手套,剪裁小指指套使之成为一个约直径1cm的半球形,将这个半球形与输液器的输液管连接,而这个输液管的另一端与测压管的一端连接在一起使之成为不漏水的水囊。另一端使用输液器的漏斗与测压管的另一端相连,形成一个封闭的系统。制作无张力剥离器:使用腰穿脑脊液测压管一根并将其下端减去使之成为一根直的测压管,并将其剪去一端使之成为22cm长;剪裁一个一次性输液器,选取输液管和漏斗备用。使用6号手术手套,剪裁小指指套使之成为一个约直径1cm的半球形,测压管的一端连接在一起使之成为不漏水的水囊。另一端使用输液器的漏斗与测压管的另一端相连,形成一个封闭的系统。将自制的无张力撑开器用手套制成的水囊置于肿瘤上下两端的脊髓和硬膜之间,缓缓打开开关并逐渐将测压管竖直,调整测压管的高度,使测压管内水柱高度不超过20cm水柱。从而达到显露肿瘤的目的。结果:13例肿瘤显露满意,并且都做到了全切除,11例术后神经功能逐渐恢复,尤其是其中有一例上颈段肿瘤,术后症状改善明显,以下肢无力恢复最为明显,9例下肢无力患者均有肌力的明显恢复。无手术死亡病例,术后随访6个月,无复发及脊柱畸形。与回顾性资料相比较,使用JOA评分,与回顾性资料相比较术后改善率,P0.05,有统计学意义,可以认为实验组术后改善率占优势。结论:和传统的器械相比,使用这种无张力撑开器及剥离器在脊髓腹侧显微手术中,可以使显露更佳,更有利于完成手术,安全有效。
[Abstract]:Objective: to evaluate the safety and effectiveness of a self-made tension-free distractor and dissection in microsurgery for ventral spinal cord tumors. Methods: thirteen patients with ventral spinal cord tumor were treated with self-made tension-free distraction apparatus and dissecting apparatus, and 12 cases with conventional use of metal nerve dissecting apparatus and cotton slice were analyzed retrospectively. The effect and recovery of the operation were compared. How to make a tensionless distractor: use a lumbar puncture cerebrospinal fluid manometry tube and subtract it into a straight barometric tube at the lower end, and cut off one end to make it 22cm long; cut a disposable infusion tube. Select infusion tube and funnel to reserve. Using the surgical glove No. 6, the little finger sleeve is cut to make it a hemispherical shape about the diameter of 1cm, which is connected to the infusion tube of the infusion device. The other end of the infusion tube is connected to one end of the barometric tube to make it a watertight bag. The funnel at the other end of the transfusion is connected to the other end of the barometer to form a closed system. Make a tensionless stripper: use a lumbar puncture cerebrospinal fluid manometry tube and subtract it into a straight barometric tube, and cut off one end to make it 22cm long; cut a disposable infusion device and select the infusion tube and funnel to reserve. Using surgical glove No. 6, the little finger sleeve is cut to make it a hemispherical shape about the diameter of 1cm, and one end of the pressure tube is connected together to make it a watertight sac. The funnel at the other end of the transfusion is connected to the other end of the barometer to form a closed system. The water sac made with gloves made by ourselves is placed between the spinal cord and dura of the upper and lower ends of the tumor, slowly opening the switch and gradually straightening the pressure measuring tube, adjusting the height of the pressure measuring tube, so that the water column height in the pressure measuring tube does not exceed the 20cm water column. In order to achieve the purpose of exposing the tumor. Results 13 cases of tumors showed satisfactory exposure, and all of them achieved total excision in 11 cases. The neurological function recovered gradually after operation, especially in one case of upper cervical segment tumor, and the symptoms were improved obviously after operation. The recovery of lower extremity weakness was most obvious in 9 patients with lower extremity weakness. No postoperative death, 6 months follow-up, no recurrence and spinal deformity. Compared with the retrospective data, the improvement rate of JOA score was significantly higher than that of the retrospective data (P 0.05), and the improvement rate of the experimental group was higher than that of the control group. Conclusion: compared with the traditional instruments, the use of the tension-free distractor and dissection device in the ventral spinal cord microsurgery can make it more exposed, more conducive to the completion of the operation, safe and effective.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.42

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