半椎板显微手术入路治疗椎管内神经鞘瘤的临床应用

发布时间：2019-03-13 21:59

【摘要】：目的:探讨椎管内神经鞘瘤的临床表现、影像学特点以及半椎板显微手术入路在治疗椎管内神经鞘瘤中的临床应用。方法:对广西医科大学第一附属医院及第二附属医院神经外科2015年1月—2015年12月收治且术后病理确诊为椎管内神经鞘瘤25例经半椎板显微入路手术患者的临床资料进行回顾性分析,并对手术时间、术中出血量、肿瘤全切率、住院时间,术后有无脑脊液漏、各节段椎体术前术后JOA评分和VAS评分,术后随访情况等资料进行研究,并结合文献复习,进行总结。结果:25例椎管内神经鞘瘤患者,其中男性患者14例,女性患者11例,年龄12-62岁,平均40.80±13.79岁,手术时间60-480min,平均(234.64±91.93)min,出血量50-600ml,平均(300.00±126.66)ml,住院天数13—34天,平均(21.28±5.26)天。大部分首发症状为根性疼痛,随病情进展,出现一侧或双侧肤体乏力或麻木或浅感觉减退11例,出现一侧或双侧肤体疼痛6例,出现腰痛症状4例,出现四肢乏力或麻木或浅感觉减退3例,出现括约肌障碍1例。所有患者均行MRI且能较好的显示病灶。25例患者均接受了半椎板显微手术入路外科手术治疗,全切率100%,术后病理证实为神经鞘瘤。术后未发生脑脊液漏。颈椎术前JOA评分8.875±1.4577,颈椎术后JOA评分14.375±1.479,两者差异具有统计学意义(t=-29.103,P=0.000)。胸椎术前JOA评分5.208±0.6201,胸椎术后JOA评分8.875±0.6077,两者差异具有统计学意义(t=-19.501,P=0.000)。腰椎术前JOA评分12.800±3.5637,腰椎术后JOA评分23.400±2.7019,两者差异具有统计学意义(t=-9.842,P=0.001)。椎管内神经鞘瘤术前JOA评分6.56±0.712,颈椎术后JOA评分1.72±0.678,两者差异具有统计学意义(t=32.435,P=0.000)。术后症状较术前有明显改善,术后随访6—12个月均未发现肿瘤复发,未发现脊柱不稳定及畸形。结论:椎管内神经鞘瘤MRI表现具有特征性,有助于诊断,并对进一步治疗有指导意义。半椎板显微手术切除椎管内神经鞘瘤具有创伤小,恢复快,能最大限度的维持脊柱稳定性等优点,取得较好疗效,是一种安全有效手术方式,值得临床推广。但是由于暴露范围的限制,采用半椎板显微手术切除椎管内肿瘤要掌握其适应症,选择合适的病例,对椎管内巨大肿瘤和多发肿瘤应慎重选择。
[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 卤13.79 years. The operative time was 60? 480min and the average bleeding volume was (234.64 卤91.93) min, 50? 600ml. The average hospital stay was (300.00 卤126.66) ml, for 34 days and (21.28 卤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 卤1.4577, and the postoperative JOA score was 14.375 卤1.479. The difference was statistically significant (t = 29.103, P < 0.000). The preoperative JOA score was 5.208 卤0.6201, and the post-thoracic JOA score was 8.875 卤0.6077. There was a significant difference between the two groups (t = 19.501, P < 0.001). The preoperative JOA score was 12.800 卤3.5637, and the post-operative JOA score was 23.400 卤2.7019. The difference was statistically significant (t = 9.842, P < 0.001). The preoperative JOA score of intraspinal neurinoma was 6.56 卤0.712, and the JOA score of postoperative cervical spine was 1.72 卤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.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.42

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