半椎板切除显微手术治疗椎管内肿瘤542例临床分析

Clinical analysis of 542 intraspinal tumors microsurgically resected by hemilaminectomy

目的探讨半椎板切开显微手术治疗椎管内肿瘤的优缺点和适应证。方法回顾性分析四川大学华西医院神经外科从2005年1月至2008年12月采用半椎板切开显微手术切除的542例椎管内肿瘤的临床资料。男345例，女197例，年龄5～72岁（平均37岁），病程1个月～10年（平均3．6年），临床表现为不同程度脊神经和（或）脊髓压迫的症状和体征。结果肿瘤全切501例（92％），术后平均住院时间5．2d。术后随访6个月～3年（平均9个月），临床症状改善495例（91％），肿瘤全切病例均无复发，所有病例脊柱稳定性良好，均未发生脊柱畸形。结论半椎板切除术创伤小，术后反应轻，恢复快，脊柱稳定性良好。凡偏向一侧生长的硬脊膜外和髓外硬脊膜下肿瘤以及部分髓内良性肿瘤均可采用半椎板切开显微手术切除。

Objective To investigate the advantages, disadvantages and indications of hemilaminectomy for microsurgical resection of intraspinal tumors. Methods We retrospectively reviewed and analyzed the clinical data of 542 cases of intraspinal tumors microsurgically resected by hemilaminectomy during the period from January 2005 to December 2008. Results The tumors were totally removed in 501 cases （92%）. The average postoperative stay was 5.2 days. Postoperative follow-ups ranged from 6 months to 3 years （mean 9 months）. The clinical symptoms of 495 cases （91%） improved. No tumor recurrence was reported in the totally removed cases. The stability of vertebral column was excellent and there was no spinal deformity in these patients. Conclusion With many advantages of minimal trauma, milder postoperative reaction, shorter length of recovery and better spinal stabilization, hemilaminectomy can be used for microsurgical resection of all lateralized epidural, subdural-extramedullary and some benign intramedullary tumors.