臂丛神经鞘瘤的分区、分型和显微外科治疗

发布时间：2018-04-08 15:36

本文选题：臂丛　切入点：神经鞘瘤　出处：《中国微创外科杂志》2017年12期

【摘要】：目的探讨臂丛神经鞘瘤的分区、分型以及显微外科治疗要点。方法回顾性分析2010年6月~2017年1月臂丛神经鞘瘤23例资料,根据肿瘤主体相对锁骨的位置分为锁骨上区、锁骨下区、锁骨内侧三角区,根据肿瘤累及臂丛的位置分为近侧型、远侧型以及中间型,后两型又包括前方型和后方型。锁骨上区肿瘤采用胸锁乳突肌后入路、颈后三角内沿皮纹横切口入路以及锁骨上入路,锁骨下区肿瘤行贴近锁骨上缘的锁骨上入路,锁骨内侧三角区肿瘤行切开胸锁乳突肌锁骨头的锁骨上入路。均行显微外科手术切除,术中行神经电生理监测。结果位于锁骨上区18例,锁骨下区1例,锁骨内侧三角区1例,锁骨上区和锁骨下区1例,锁骨上区和锁骨内侧三角区2例;近侧型7例,前-远侧型1例,前-中间型11例,后-中间型4例。23例均完全切除肿瘤,术后病理类型Antoni A型15例,B型8例。术后1例感觉症状加重,2例肌力下降伴感觉症状加重,随访过程中恢复正常,余患者术后症状均消失,随访6~72个月,平均29.8月,无肿瘤复发。结论显微外科治疗臂丛神经鞘瘤安全有效。新的臂丛神经鞘瘤分区有助于指导手术入路的选择,新的分型有助于指导术中操作进而减少术中并发症。
[Abstract]:Objective to study the classification, classification and microsurgical treatment of brachial plexus schwannoma.Methods the data of 23 cases of brachial plexus neurilemmoma from June 2010 to January 2017 were retrospectively analyzed. According to the position of the tumor body relative to the clavicle, the tumors were divided into supraclavian area, subclavian area, medial clavicular triangle area and proximal type according to the location of the tumor involving brachial plexus.The distal type and the middle type, the latter two types including the front and rear type.The supraclavian tumors were treated by the posterior approach of sternocleidomastoid muscle, the transverse incision along the cutaneous stria of the posterior cervical triangle and the supraclavicular approach. The tumor in the subclavian region was treated by the supraclavicular approach close to the superior edge of the clavicle.The medial clavicular trigonometry was performed through the supraclavicular approach to the sternocleidomastoid muscle clavicular bone.All patients underwent microsurgical resection and electrophysiological monitoring.Results 18 cases were located in supraclavicular area, 1 case in subclavian area, 1 case in medial clavicular triangle, 1 case in supraclavicular and subclavian area, 2 cases in supraclavicular area and medial clavicular triangle, 7 cases were proximal type, 1 case was anterior to distal type, 11 cases were anterior and intermediate type.The tumor was completely resected in 4 cases of posterior to intermediate type and 8 cases of type B in 15 cases of Antoni A type after operation.The sensory symptoms were aggravated in 1 case and the muscle strength decreased and the sensory symptoms increased in 2 cases. The symptoms of the remaining patients were all disappeared during the follow-up. The follow-up for 6 ~ 72 months (mean 29.8 months) showed no recurrence of tumor.Conclusion microsurgical treatment of brachial plexus schwannoma is safe and effective.The new subdivision of brachial plexus schwannoma is helpful to guide the choice of operative approach, and the new classification is helpful to guide intraoperative operation and reduce intraoperative complications.
【作者单位】：北京大学第三医院神经外科;
【基金】：北京市自然科学基金(7144253)
【分类号】：R739.4

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