椎管内髓外硬膜下肿瘤的临床特点及病理学构成——167例病例分析

The clinical characteristics and histological type of intradural extramedullary tumors: analysis of 167 cases

目的 ：总结椎管内髓外硬膜下肿瘤的临床特点及病理学构成情况。方法 ：对2006年1月-2014年8月本院脊柱外科收治的167例、平均年龄49.5岁的椎管内髓外硬膜下肿瘤患者的一般情况、影像学资料和病理诊断进行回顾性的统计分析。结果：髓外硬膜下肿瘤女性∶男性比例为1.17∶1,167例患者中75.6%存在疼痛症状,40.1%存在感觉障碍,34.9%存在运动障碍,4.4%合并有大小便功能障碍。髓外硬膜下肿瘤患者中有120例神经鞘瘤,34例脊膜瘤,其他类型肿瘤相对较少。神经鞘瘤患者的平均年龄为47.3±1.3岁,脊膜瘤患者的平均年龄为57.5±2.6岁;神经鞘瘤患者男女比例为1.14∶1,脊膜瘤患者女性∶男性比例为5.8∶1,两者差异具有统计学意义（P〈0.001）。神经鞘瘤好发于胸腰段（47.9%）,脊膜瘤好发于胸段（35.3%）。神经鞘瘤和脊膜瘤的根性疼痛症状所占比例分别为67.5%和35.3%,感觉障碍症状为28.2%和76.5%,肌力减退症状为25.6%和73.5%,均有显著性差异（分别为P=0.001,P〈0.001,P〈0.001）。神经鞘瘤和脊膜瘤的体积无显著性差异（P〉0.05）。在肿瘤体积在10cm3以内的亚组分析中,神经鞘瘤的平均体积为（3.5±2.2）cm^3,脊膜瘤的平均体积为（2.3±1.8）cm^3,两者具有显著性差异（P=0.005）。结论：椎管内髓外硬膜下肿瘤主要以神经鞘瘤和脊膜瘤为主。脊膜瘤的平均发病年龄比神经鞘瘤大;神经鞘瘤好发于胸腰段,脊膜瘤好发于胸段;神经鞘瘤的症状以根性疼痛为主,脊膜瘤的症状以感觉和运动障碍为主。

Objectives： To summarize the histological type and clinical characteristics of intradural extramedullary tumors. Methods： To retrospectively analyze the general conditions, MRI images and pathological diagnosis of 167 patients diagnosed with intradural extramedullary tumors. Results： The average age of patients with intradural extramedullary tumors was 49.5 years old, and the ratio of female/male was 1.17 ∶1. Among the patients with schwannomas, the ratio of male/female was 1.14 ∶1. Among the patients with spinal meningiomas, the ratio of female/male was 5.80 ∶1. Among the 167 patients with intradural extramedullary tumors, pain occurred in 75.6% patients, numbness and/or tingling occurred in 40.1% patients, weakness and/or paralysis occurred in 34.9% patients, and urinary and fecal incontinence occurred in 4.4% patients. 120 pa-tients were diagnosed with schwannomas, and 34 patients were diagnosed with spinal meningiomas. The mean age of patients with schwannomas was 47.3 ±1.3y, and was 57.5±2.6y with spinal meningiomas（P〈0.001）. The majority of schwannomas located near thoracic-lumbar spinal canal（47.9%）. The majority of spinal menin-giomas located in thoracic spinal canal（35.3%）. The ratio of radiating pain in schwannomas and spinal menin-giomas were 67.5% and 35.3% respectively（P=0.001）, which were 28.2% and 76.5% of sensory disturbance（P〈0.001）, and 25.6% and 73.5% of movement disorders（P =0.001）. There were no statistical difference between the volume of schwannomas and spinal meningiomas（P〉0.05）. However, in the analysis of subgroup of tumor volume less than 10cm3, schwannomaswere larger than spinal meningiomas（3.5 ±2.2cm^3 vs 2.3 ±1.8cm^3, P =0.005）. Conclusions： The majority of intradural extramedullary tumors were schwannomas and spinal meningiomas. The mean age of patients with schwannomaswas larger than that with spinal meningiomas. The majority of schwannomas were located near thoracic-lumbar junction spinal canal, and the majority of spinal meningiomaswere located in thoracic spinal canal. The symptom of schwannomas was radiating pain, and the symptom of spinal meningiomas were sensory disturbance and movement disorders.