椎管内硬膜下肿瘤的手术治疗.DOCVIP

临床医学论文-椎管内硬膜下肿瘤的手术治疗 ??????????????? 作者：吴玉杰，贾连顺，崔学文，宋希元??????????? ????? 【关键词】? 颈髓；椎管内肿瘤；硬膜下肿瘤；手术治疗 　　摘? 要：［目的］探讨颈椎管内硬膜下肿瘤的手术治疗方法及疗效。［方法］回顾性分析经手术治疗的21例颈椎管内硬膜下肿瘤患者的临床资料及治疗效果，所有病人均行颈椎后路椎板切除椎管减压进行肿瘤切除，部分病人并行后路钉棒系统内固定。［结果］15例完全切除，4例次全切除，2例部分切除；症状消失13例，症状减轻7例，症状恶化1例，无死亡病例发生。［结论］术前根据影像学资料仔细评价肿瘤大小及肿瘤与脊髓的关系是决定手术成功的关键，术中仔细操作避免损伤脊髓，并注意保护好椎动脉及防止椎管内静脉丛大出血，是将肿瘤完全切除的前提。 ??? 关键词：颈髓；椎管内肿瘤；硬膜下肿瘤；手术治疗 ?????? Abstract：［Objective］To investigate results of surgical treatment of intradural tumors of the cervical spinal cord［Method］Twentyone cases with cervical intradural tumor were treated surgically under posterior approach from 1999 to 2005,all patients were performed cervical laminae resection before tumor resection,and some received internal fixationAll patients were followed up for 8 months to 38 months respectivelyAll the clinical materials were analyzed retrospectively［Result］All patients survived the operation,symptoms disappeared 13,relieved 7 and deteriorated 1Total resection in 15 cases,subtotal 4 cases and partial 2 cases［Conclusion］To succeed the operation,it is very important to make clear the location and size of the tumor and the relationship between the tumor and spinal cord;in order to gain total resection of tumor,both careful protection of spinal cord and vertebral artery and intraspinal cannal veins are essence ??? Key words：Cervical spinal cord;? Spinal canal tumor;? Intradural tumor;? Operation ??? 1? 临床资料 ??? 11? 一般资料 ??? 本组21例，男14例，女7例;平均年龄414（16～69）岁；病程3～52个月，平均167个月。肿瘤部位及大小：上颈椎椎管内肿瘤9例，下颈椎12例，位于单一椎体节段5例，跨越2个椎体节段13例，跨越3个椎体节段3例。肿瘤与脊髓关系：髓外硬膜下16例，髓内5例。术后病理类型：室管膜瘤3例，神经鞘瘤11例，角质细胞瘤4例，星形细胞瘤3例。 ??? 12? 主要症状与体征 ??? （1）感觉障碍及疼痛：本组病例中均有不同程度的感觉障碍，表现为有感觉障碍平面异常伴有麻木、束带感或刺痛感，感觉障碍平面与脊髓肿瘤所在部位有关。（2）运动障碍：本组病例均有不同程度运动障碍，主要为下肢肌力减退，肌力减退Ⅰ～Ⅲ级不等，其中4例病程长者伴有明显的肌肉萎缩。（3）括约肌功能障碍：本组有5例患者有尿失禁症状。 ??? 13? 辅助检查 ??? （1）脊柱X线检查：本组21例均行颈椎X线片检查；其中2例见有椎体弧形压迹改变，3例可见椎间孔扩大、椎弓根距离增宽改变，其余病例均正常。（2）CT检查：本组21例中有5例行CT检查能对肿瘤进行定位。（3）MRI检查：本组21病例中16例行MRI检查获得肿瘤部位及范围的准确定位。 ??? 2? 手术治疗 ??? 21? 手术方法 ??? （1）行颈椎后路椎板切除单纯肿瘤切除