脊髓髓内肿瘤的显微外科治疗及临床观察

Microsurgical treatment and clinical observation of intramedullary spinal cord tumors

目的 总结脊髓髓内肿瘤的显微手术经验 ,并对其并发症的处理及疗效进行评价。方法 对 48例髓内肿瘤采用显微外科手术。术中取侧卧位或半坐位 ,正中切口 ,尽量做到全切 ,并观察其术后的并发症及处理。结果 本组室管膜瘤、星形细胞瘤、脂肪瘤和血管网状细胞瘤分别占髓内肿瘤的 3 7.5 %、2 9.2 %、2 0 .8%、10 .4% ,其全切率分别为 88.9%、2 8.6%、10 .0 %、60 .0 % ;1例转移瘤全切。术后早期有感觉缺失 ,主要并发症有感染。 48例全部随访 ,平均 3 0 .4个月 ,大部分病人术后 1～ 3个月功能好转或无继续恶化 ,47例存活 ,1例死亡。结论 脊髓髓内肿瘤以良性及低恶性度肿瘤多见 ,手术效果较好 。

Objective To study the microsurgical treatment and assess the value and complication of the microsurgical treatment of intramedullary spinal cord tumors.Methods Forty-eight patients with intramedullary spinal cord tumor were operated by microsurgery at Department of Neurosurgery in Union Hospital.All the tumors needed to be totally removed at mostly with the lateral recumbent position or emi-sitting position median incision.There were observations of postoperative Complicationa and treatment.Results Ependymomas,Astrocytomas,Lipomas and Hemangioblastomas accounted for 37.5%,29.2%,20.8% and 10.4% in intramedullary spinal cord tumors,and their total removed rate were 88.9%,28.6%,10.0%,and 60.0% respectively,one metastasis was acquired total remove.Anaesthesia appeared earlier and the infection was the main Complication after operation.Forty-eight patients were followed up for an average of 30.4 months.Functional grades Most patients at their preoperative grade level or improved.Forty-seven patients were alive and one died.Conclusion Benign tumors and low grade malignant tumors are commonly seen in intramedullary spinal cord tumors,and early operation is essential to better outcome.