显微手术治疗脊髓肿瘤108例临床分析

Microsurgical treatment of spinal cord tumor:Clinical analysis of 108 cases

目的探讨脊髓肿瘤的诊治经验。方法回顾性分析108例脊髓肿瘤病例资料,均行显微手术切除,其中全椎板切除38例,椎板成形术52例,半椎板切除18例;多节段病例行钉棒固定6例。结果术后病理:神经鞘瘤42例,脊膜瘤31例,室管膜瘤15例,星形细胞瘤14例,其他6例。术后MRI复查示肿瘤全切除91例(84.3%),大部分切除15例(13.9%),活检2例(1.9%)。术后并发脑脊液漏4例,颅内感染2例,经对症处理后痊愈;本组无死亡病例。以术后6个月随访作为效果评价终点,优50例,良38例,改善8例,差12例,有效率(包括优、良及改善) 88.8%。结论 MRI检查能早期诊断脊髓肿瘤,应用显微手术切除肿瘤,选择适当固定方式,既可获得肿瘤有效切除治疗,又可达到保持脊柱稳定性的效果。

Objective To explore the experience in diagnosis and treatment of spinal cord tumors. Methods The clinical data of 108 patients with spinal cord tumors were analyzed retrospectively. All the patients underwent microsurgical resection, including total laminectomy in 38 cases, laminoplasty in 52, hemilaminectomy in 18;and 6 patients with multi-segment lesion underwent nail-rod fixation. Results Postoperative pathological diagnosis was schwannoma in 42 cases, meningioma in 31, ependymoma in 15,astrocytoma in 14 and other in 6. Postoperative MRI review showed total resection was achieved in 91 cases(84.3%), subtotal resection in 15(13.9%), and biopsy in 2(1.9%). There was postoperative cerebrospinal fluid leakage in 4 cases and intracranial infection in 2, which were cured after symptomatic treatment;there was no death case. The 6-month follow-up was used as the end point of the effect evaluation. The therapeutic effect was excellent in 50 cases, good in 38, improved in 8 and poor in 12. The overall response rate(including excellent, good and improvement) was 88.8%. Conclusions MRI can diagnose spinal cord tumor in early stage.Microsurgery can be used to remove the tumor and appropriate fixation can not only achieve effective resection of the tumor, but also maintain the stability of the spine.