儿童后纵隔椎管肿瘤的分型和治疗

Classification and surgical management of posterior mediastinal and spinal dumbbell tumors in children

目的探讨小儿后纵隔椎管肿瘤的分型和手术方式,以提高对该病的认识及疗效。方法男12例,女11例,年龄5个月至6岁,平均(2.3±1.6)岁。术前均摄胸部X线光片、CT或MRI并进行分型:Ⅰ型5例;Ⅱ型6例;Ⅲ型11例;Ⅳ型1例;椎管内的肿瘤均位于硬膜外;术前依据分型选择适当的治疗方案。结果23例中良性11例,其中畸胎瘤1例、肠源性囊肿3例、神经节细胞瘤7例;恶性12例,其中恶性神经鞘瘤1例、节细胞性神经母细胞瘤1例、神经母细胞瘤10例。16例行椎管及纵隔同期手术,7例进行了分期手术。随访1-8年,17例有神经症状中的13例均不同程度改善或恢复正常。结论影像学检查结合临床表现是儿童后纵隔椎管肿瘤诊断、分型和确定手术方案的主要方法,神经外科和胸外科同期手术是治疗小儿后纵隔椎管肿瘤安全有效的方式。

Objective To evaluate the classification and surgical management of “dumbbell tumor” in mediastinum and spinal in children. Methods There were 12 boys and 11 girls with age from 5 months to 6 years （ mean age 2.3± 1.6 years ）. All cases were undertook the plain chest film, CT and/or MRI before operation and were classified into 4 types ： type I in 5 cases, type 11 in 6 cases ; type IU in 11 cases and type IV in 1 case. Tumor located in extradura in all cases, was choose suitable surgical approach. Results Benign tumors was in 11 cases, malignant ones was in 12 cases. 16 children were undertook one- stage operation which combined with neurosurgical and thoracic technique together, 7 cases were undertook two or three-stage operation. Follow up time is from one year to eight years, clinical symptoms were improved or completely resumed in 13 cases. Conclusions Imaging examination is a very important way to diagnose and to classify the “dumbbell tumor” of mediastinum with spinal extension in children, a one-stage operation combined thoracic and neurosurgical approach is safe and will lead to a good long-term result.