椎管内肿瘤的临床诊断及手术效果

Analysis of the clinical diagnosis and surgical treatment of intraspinal tumors

目的:总结椎管内肿瘤诊断重点、评价手术疗效并解析相关注意事项。方法:回顾性分析我科2006年10月-2014年10月收治的164例经手术治疗椎管内肿瘤患者的临床资料,总结诊断重点、评析手术疗效及相关注意事项。结果:椎管内肿瘤临床症状迥异多变,主要表现为疼痛、感觉及运动障碍,且症状与肿瘤所处节段、部位、大小密切相关。MRI诊断肿瘤及定位准确率100%,其中122例术前MRI定性诊断与术后病理诊断相符合,占74.4%。肿瘤复发8例。末次随访时ASIA分级除10例患者无改变和4例患者加重外,余150例患者均有1-2级改善,与术前比较差异有统计学意义(Z=-12.617,P=0.000)。行脊柱椎弓根螺钉内固定57例(颈椎11例,胸椎3例,腰椎43例),164例患者术后脊柱均稳定。4例并发脑脊液漏,2例并发术后血肿,经处理治愈。结论:椎管内肿瘤临床表现复杂多变,MRI有肿瘤定位、定性、判断脊髓神经受压、缺血状态、指导手术等意义。后路手术显露范围及脊柱稳定重建与否应据肿瘤所处节段、节段脊柱结构缺失程度、功能需要等综合决定。手术及神经功能风险预估应与患者良好沟通。

Objective： To summarize the diagnostic key of the intraspinal tumors and evaluate the effect of surgery.Methods： A retrospective analysis of 164 patients with intraspinal tumors treated with surgery from 2006 to 2014 was conducted to summarize the diagnostic key and evaluate the effect of surgery. Results： The clinical symptoms of intraspinal tumors varied,the main manifestations were pain,sensory and movement disorders. The symptoms were closely related to the segment,location and size of the tumors. The accuracy rate of MRI to tumor localization was 100%,and 122 cases of MRI were in accordance with the pathological diagnosis,accounting for 74. 4%. There were 8 cases of tumor recurrence. At last follow- up,ASIA grade was improved significantly（ Z =- 12. 617,P = 0. 000） compared with preoperative grade except 10 patients without change and 4 cases of patients were increasing. There were 57 cases of spinal pedicle screw internal fixation（ 11 cases of cervical vertebra,3 cases of thoracic vertebra,43 cases of lumbar vertebra） and 164 cases of spinal stability after operation were performed. The complications included 4 cases of cerebrospinal fluid leakage,and 2 cases of postoperative hematoma,which was cured by treatment. Conclusion： Although the clinical manifestations of intraspinal tumors are complex and varied,MRI has the significance of tumor location,qualitative analysis,spinal nerve compression,ischemic state,and guidingthe surgery. The exposure range of posterior approach surgery and spinal stability reconstruction should be determined by the tumor segment,the extent of the loss of the structure of the segment,and the functional requirements. Surgery and neurological function risk estimates should be good communication with patients.