颈部神经鞘瘤77例的诊断与治疗

Diagnosis and treatment for cervical neurilemmoma in 77 cases

目的总结颈部神经鞘瘤的诊断与治疗经验。方法回顾性分析1976-2005年收治的77例颈部神经鞘瘤患者的临床资料。结果根据病史、临床表现特点、辅助检查(B超、CT)以及细针穿刺抽吸活检可作出诊断,本组确诊51例,确诊率66．2％(51／77),误诊26例,误诊率高达33．8％(26／77)。本组77例均行手术切除。术后病理诊断为良性神经鞘瘤。术后并发症有喉返神经损伤6例,Homer征4例,伸舌偏斜3例,颈侧疼痛、麻木2例,上肢放射性疼痛1例。该16例术后随访3-11个月症状均恢复。术中误切迷走神经3例,2例术后有神经功能障碍;误切交感神经1例,术后有功能障碍。2例误切迷走神经及误切1例交感神经者随访3年功能稍有恢复,以后失访。结论B超和CT,特别是细针穿刺抽吸活检有助于诊断。手术切除是有效的治疗方法。

Objective To summarize the experience on clinical diagnosis and treatment for cervical neurilemmoma. Methods The clinical data of 77 cases of cervical neurilemmoma from 1976 to 2005 were retrospectively analyzed. Results The diagnosis was dependent on the anamnesis, clinical presentations, ultrasonography, CT and cytology of fine needle aspiration. Correct preoperative diagnosis was abtained in 51 cases （66.2%）, and the misdiagnosis rate was 33. 8% （26/77）. All patients underwent surgical resection. The postoperative diagnosis was benign neurilemmoma by pathological examinations. The postoperative complications included recurrent laryngeal nerve injuries （6 cases ）, Homer syndrome （4 cases）, tongue deviation（3 cases）, neck pain or numbness （2 cases） and reffered pain in limb （ 1 case）. Sixteen patients were followed up, and these symptomes disappeared after 3 - 11 months. Nerve dysfunction remained in 2 out of 3 patients in whom the vagus was wrongly amputated during the operation. Intraoperative inadvertent sympathetic nerve amputation caused permanent nerve dysfunction. Conclusion B-mode ultrasonography, CT and fine needle aspiration cytology are useful for the diagnosis of cervical neurilemmoma. Surgical resection is most effective among all available therapies.