内镜辅助半椎板入路下椎管内肿瘤手术治疗的临床疗效观察

Clinical observation of under endoscopic assisted semi-laminectomy approach on the treatment of intra-spinal tumor

目的分析椎管内肿瘤患者在神经内镜下行肿瘤切除术的疗效及并发症，总结内镜下椎管内肿瘤手术的治疗体会。方法回顾性分析山西省人民医院神经外科2008年1月-2015年9月收治的24例椎管内肿瘤患者的病例资料，术前经MRI检查均确诊为椎管内占位，应用神经内镜行肿瘤切除手术治疗，术后对患者进行长期随访，观察疗效与并发症。结果全部患者术后症状均有不同程度的改善，感觉障碍程度减轻，肢体肌力增强，神经电生理学损害减轻。术后未见严重并发症出现。24例患者中，肿瘤全切除17例，大部分切除7例。伴有脊髓栓系者术中同时行栓系松解术。结论内镜辅助半椎板入路椎管内肿瘤切除术，对周围结构损伤轻微，对脊椎解剖结构影响小，方法可行，疗效明确，定位准确，且术后恢复快，是一种新型、安全、有效的手术途径。

Objective To retrospective analysis of the clinical effect and complications of the semi-laminectomy approach on the treatment of intra-spinal tumor. To summarize the endoscopic treatment experience of intra-spinal tumor. Methods To retrospective analysis of the clinical data of 24 cases with intra- spinal tumor in Shanxi Provin- cial People＇s Hospital from January 2008 to September 2015. The diagnosis of the intra-spinal tumor was confirmed by preoperative MRI examination. Intraoperative application of endoscopic surgery in the resection of tumor. Long- term followed up of patient was implemented and observe the efficacy and complications after surgery. Results Postoperative symptoms of all patients have different degrees of improvement, the degrees of sensory disorder was re- duce, the limb muscle strength was increased and alleviate the damages of nerve electrophysiology. No serious com- plications were found after operation. Of the 24 patients, 17 cases were total resection of the tumor and 7 cases were subtoal resection of the tumor. Tethered cord release was operated in patients with tethered spinal cord. Conclusions Endoscopic resection assisted semi-laminectomy approach of intra-spinal tumor has slight damage to the surround structures and the impact to the anatomy of the spine was small. Endoscopic assisted semi-laminectomy approach may have siginfieant clinical effect on intra-spinal tumor, and have good security.