脊髓胶质瘤的显微外科治疗.docVIP

脊髓胶质瘤的显微外科治疗 作者：洪国良， 杨新宇， 岳树源， 杨树源 【摘要】 目的 探讨脊髓胶质瘤的显微手术效果和预后。 方法 回顾性分析113例脊髓胶质瘤的手术治疗经验。本组术前McCormick分级Ⅰ级22例，Ⅱ级46例，Ⅲ级31例，Ⅳ级12例，Ⅴ级2例。均行显微手术切除肿瘤，术后对未能全切除的47例均行放射治疗。 结果 脊髓胶质瘤全切除66 例，次全切除25 例，部分切除或活检22 例。对105例行6~186个月随访，McCormick分级改善48 例，无变化46 例，加重8例，死亡3 例。 结论 利用显微外科技术切除脊髓胶质瘤，大多数病例可以做到次全切除或全切除，预后满意；不能全切除者可辅以放射治疗。 【关键词】 脊髓肿瘤 神经胶质瘤 显微外科手术 Microsurgery for spinal cord gliomas Abstract: Objective To explore the microsurgical efficacy and prognosis of spinal gliomas. Methods The surgical experience with resection of spinal cord glioma in 113 patients was retrospectively analyzed. Preoperative McCormick grade was Ⅰ in 22 cases, Ⅱ in 46, Ⅲ in 31, Ⅳ in 12, and Ⅴ in 2. All the patients were operated on by microsurgical techniques. Postoperative radiological treatment was performed in 47 patients who did not receive total resection of the tumor. Results Total tumor resection was achieved in 66 cases, subtotal in 25, and partial or biopsy in 22. One hundred and five patients were followed up from 6 to186 months respectively. Among them, McCormick grade was improved in 48 cases, unchanged in 46, deteriorated in 8, and dead occurred in 3. Conclusion Using microsurgical techniques, total or subtotal tumor remove can be achieved with a satisfactory prognosis in a majority of spinal cord glioma patients. Radiotherapy could be applied to those patients who did not receive total resection of the tumor. Key words: spinal cord neoplasms; gliomas; microsurgery 自1988~2005年间，我院共对113例脊髓胶质瘤行手术治疗，占同时期脊髓髓内肿瘤 （160例） 的70.6%，现就脊髓胶质瘤显微外科技术的特点以及影响病人预后的因素进行探讨。 1 对象与方法 1.1 临床资料 男70 例，女43 例，男∶女= 1.6∶1；年龄6~72岁，平均42.5岁。首发症状：运动障碍54例，感觉障碍39例，括约肌功能障碍8例，神经根疼痛12例。手术前McCormick神经功能分级为Ⅰ级22 例，Ⅱ级46 例，Ⅲ级31 例，Ⅳ级12 例，Ⅴ级2例。均行MRI检查，显示肿瘤位于颈段55例，胸段45例，腰段13例。 1.2 手术过程 手术在全麻下进行，早期44例采用传统侧卧位，近10年均采用俯卧位 （颈段肿瘤需要用头架固定头部）。脊髓切开的长度不小于肿瘤全长，用锐利的角膜刀在显微镜下准确地沿后正中线切开脊髓，不可偏离以免造成传导束的损伤；对于少数肿瘤粗大而于脊髓一侧穿透白质或脊髓局部白质变得菲薄者，也可在此处行纵行切开。分离肿瘤要严格沿其与脊髓之间形成的界面进行，已经暴露的肿瘤床面用薄棉片轻轻覆盖；对肿瘤巨大、分离困难者可用激光刀或超声