成人原发性椎管内肿瘤的外科治疗与疗效分析·术式交流-中国肿瘤临床.pdf

中国肿瘤临床2017年第44卷第20期 ChinJClinOncol2017.Vol.44.No.20 1029 术式交流 · · 成人原发性椎管内肿瘤的外科治疗与疗效分析 高明勇 陶海鹰 卫爱林 余铃 杨博 摘要 目的：分析总结成人椎管内肿瘤的临床特点、手术方式及术后神经功能恢复及预后。方法：回顾性分析武汉大学人民医院 2008年1月至2012年12月69例手术的成人椎管内肿瘤患者的临床资料，分析椎管内肿瘤的病理学特点、治疗方法的选择、治疗 前后神经功能ASIA评分变化及预后影响主要因素。结果：成人椎管内肿瘤主要分布于髓外硬膜内（约占总数的61.3％），肿瘤位 于胸椎管内比例最高，病理类型以神经鞘瘤及脊膜瘤最多见（两者约占总数的53.5％），采取脊柱后路显露及神经显微外科技术， 91％的肿瘤可经全切治愈。ASIA评分显示术后随访神经根性疼痛、肢体感觉运动及括约肌功能均较术前改善明显，差异具有统 计学意义。结论：后路椎板切除联合神经显微外科技术，是目前椎管内肿瘤安全有效的外科治疗手段。 关键词 椎管内肿瘤 椎板切除术 外科治疗 神经功能 doi:10.3969/j.issn.1000-8179.2017.20.636 Retrospective analysis of surgical treatment and postoperative follow-up study of adult primary intraspinal tumors Mingyong GAO, Haiying TAO, Ailin WEI, Ling YU, BoYANG Correspondence to: Mingyong GAO; E-mail: mgao@,cn Department of Spine Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China Abstract Objective: To evaluate the diagnosis, surgical treatment, and neurological function recovery after surgery of patients with intraspinal tumors. Methods: The clinical data of 69 patients who suffered from intraspinal tumors and underwent surgery from Janu- ary 2008 to December 2012 were retrospectively analyzed. Neuroimaging and ASIA scoring were performed to examine the pathologi- cal characteristics of tumors and the neurological function of these patients before and after treatment. The major factors affecting prognosis were also probed, and the average follow-up period was 12.2 months. Results: Of the total cases, 62.3% showed intradural extramedullary intraspinal tumors located in the thoracic vertebra. Neurilemoma (Schwannoma) and meningioma were the most com- mon pathological types (53.5%). Posterior approaches with hemi- and complete-laminectomy were conducted to expose the intraspi- nal tumors, and