椎管内肿瘤的诊体会.docVIP

椎管内肿瘤的诊治体会 【摘要】 目的 对椎管内肿瘤的诊断和手术治疗进行探讨。方法 回顾性分析2006年6月-2008年7月我科对65例椎管内肿瘤的手术疗效结果, 根据患者肿瘤部位及年龄不同,采用不同手术方法。结果 肿瘤全切除55例,次全切除10例,其中显微外科手术19例。随访2-5 年，疼痛缓解率为88.6%（51/58）,感觉障碍改善率76.3%（50/65），运动障碍改善率90.5%（53/59），括约肌功能改善率88.9%（52/58）。结论 MRI是最具诊断价值的方法并对手术切除有指导意义,椎管内肿瘤良性居多且大多位于髓外,手术效果好，宜早诊断尽早手术，髓内病变恶性居多,疗效较差，宜适时手术为宜，采用显微外科技术可提高疗效。 【关键词】 椎管内；肿瘤；手术切除 Diagnosis and surgical treatment of in traspinal tumors 【Abstract】Objective To study the diagnosis and operation treatment of patients with intraspinal tumor. Methods :The surgical results of 65 intraspinal tumor cases from 2006-2008 were analyzed，The clinical manifestation, magnetic resonance imaging, operative treatment methods and effectswere analyzed. Results 55 cases were completely resected and 10 cases were subtotally removed. 19 were undergone microsurgery. The following up from 2 to 5 years showed that pain was relieved in 88.6% (51/58) of the patients, sense function was improved in 76.3% (50/65), motor function was improved in 90.5% (53/59), and sphincter function was improved in 88.9% (52/58). Conclusion MRI is the best way for diagnosis and it has directive function for excision, Benign intraspinal tumor of spinal canal is in the majority and many of them are located in extramedullarym, It is very effective by operation and should be early diagnosis, malignant intramedullary tumor is in the majority and has bad curative effect,micrological surgery technique has good curative effect. 【key word】Intraspinal;Tumor;Excision 　 椎管内肿瘤是中枢神经系统常见肿瘤,可发生在椎管的任何部位,好发于青壮年,多见于20～40岁[1]。随着现代检查手段的不断发展及显微手术技术的应用,对椎管内肿瘤的诊断和治疗有了很大程度的提高和改善[2]。现就2006年6月-2008年7月我科收制的65例椎管内肿瘤患者的临床诊治情况总结如下。 1 临床资料 1.1 资料　本组男40例,女25例,年龄17～68岁;其中20～40岁35例,40～60岁20 例,20 岁以下4例,60 岁以上6例,病程3个月～2年。 1.2 临床表现 椎管内肿瘤因病变部位、病理性质及与神经的关系不同而临床表现复杂多样,但亦具有以下共同表现。①疼痛: 65例中58例均有不同程度的疼痛,可为病变节段的胀痛,多数表现为根性疼痛,有时可误诊为坐骨神经痛或肋间神经痛。②感觉障碍: 65例均出现与肿瘤部位相关的感觉障碍平面,常出现麻木和束带感。③运动障碍:表现为无力,全瘫者少见,本组59例出现病变节段以下不同程度的肌力下降。④括约肌功能障碍: 58例中13例出现尿潴留或尿失禁,多为髓内肿瘤或脊髓受压严重及病程较长的患者。 1.3 影像学检查　46例行X线检查, 22例椎弓根增宽, 2