不同手术方式治疗硬脊膜外神经鞘瘤的临床分析外科学神经外科专业论文.docxVIP

浙江大学硕士学位论文摘要 浙江大学硕士学位论文 摘要 目的：本研究旨在阐明硬脊膜外神经鞘瘤的临床特点，评价不同手术方式对 手术过程及术后恢复情况的影响。 方法：本研究选取并分析了41例硬脊膜外神经鞘瘤患者， 22例为包膜内 切除组和1 9例包膜外切除组，其中包括2例内镜下行包膜外切除术的病例。肿 瘤部位：颈椎1 9例，胸椎14例，腰椎8例。主要关注肿瘤生长部位、手术过程， 并采用改良日本骨科协会评分改良JOA评分(i JOA)评估神经功能预后。 结果：回顾统计分析的41例病例分为包膜内切除组和包膜外切除组。硬脊 膜外神经鞘瘤手术切缘均经术中切片病理证实为正常神经组织。术前与随访终点 的iJOA评分改善值(p20．．I]488)以及术中出血量(p=O．01 00)，包膜内切除组明 显优于包膜外切除组；出院时神经系统体格检查以及术后并发症比较，包膜内切 除组更为有利；术后住院时间，两组间无明显统计学差异(p=0．1 003)。 结论：硬脊膜外神经鞘瘤不同于硬脊膜内的神经鞘瘤，包膜内切除的切除方 式较包膜外切除者更为安全，并能获得更好预后。脊柱内镜可用于实现微创的包 膜内切除术。 关键词： 硬脊膜外神经鞘瘤，包膜内切除，iJOA，脊柱内镜 万方数据 浙江大学硕士学位论文Abstract 浙江大学硕士学位论文 Abstract Obj ect：The authors conducted a study to evaluate the clinical characteristics and surgical outcomes in spinal epidural schwannomas patients with tumor capsules surgically kept or not． Method：Forty—one spinal epidural schwannoma patients were analyzed in this study，with 22 undergoing intracapsular enucleation while 1 9 for extracapsular resection， including 2 patients performed intracapsular enucleation with neuroendoscope technology．There were 1 9 cervical dumbbell schwalmoma， 1 4 thoracic dumbbell schwannoma and 8 lumbar dumbbell schwannoma．We mainly focused on the tumor locations，the process of surgeries and the neurological prognosis assessed according to Improved Japanese Orthopaedic Association Score (iJOA)system． Results：In total group of 41 spinal dumbbell schwannoma patients，the incisal margin of spinal epidural sehwannoma is pathologically proved to be normal nerve tissue．During neurological examinations and iJOA scoring，patients who underwent intracapsular enueleation pertbrmed significantly better than patients who underwent total removal(p2 0．04 8 8)．The anlount of bleeding during operation also showed great advantages of intracapsular enucleation over capsule sacrificing ways LD=O．oloo)． There was no differences between two groups in post operation hospitalization duration①20．1003)． Conclusion：Spinal epidural schwannoma is different from intradural schwannoma．Intracapsular enucleation freque