臂丛及周围神经鞘瘤手术治疗38例

Schmannomas in brachial plexus and peripheral nerves:surgical treatment of 38 cases

[目的]探讨臂丛及周围神经鞘瘤的治疗要点和疗效。[方法]1999～2007年共收治经临床和病理证实的神经鞘瘤38例，其中副神经1例，颈丛皮神经2例，臂丛神经6例，膜丛神经2例，上肢神经17例，下肢神经10例。其中37例均在显微镜下获得肿瘤切除，术中均用神经电生理监测，1例将肿瘤切除后，同时行神经移植术。术前复杂部位均行MRI检查，术后所有肿瘤均经病理证实为神经鞘瘤。[结果]本组38例中，36例术后神经功能未受影响，随访6个月～7年，平均4．5年，无复发。1例尺神经鞘瘤切除后出现手内肌功能部分障碍，10d后恢复。L4神经鞘瘤行肿瘤切除神经移植术后，股四头肌肌力下降为2级减，神经移植后疗效正在随访中。[结论]（1）应用显微外科技术显微镜下操作，并采用术中神经电生理监测，可最大限度的切除肿瘤，减少复发，并保留正常神经功能。（2）对于颈部、臂从、膜丛等复杂部位的神经鞘瘤术前尽可能行MRI检查。（3）术后所有神经鞘瘤均应经病理证实。

[ Objective] To investigate the key points of treatment and effect of schmannomas in brachial plexus and peripheral nerves. [Method] Thirty -eight cases of schwannomas in brachial plexus and peripheral nerves were verified with pathology and clinical from 1999 to 2007. There were one case in accessory nerve, 2 cases in cervical plexus cutaneous nerve, 6 cases in brachial plexus, 2 cases in lumbar plexus, 17 cases in upper extremity, 10 cases in lower extremity. Microsurgical removal of the tumors was done in 37 cases. They were monitored with negro - electro phsiology in operation. The other one case was repaired for nerve grafting after the tumor was cut off. The complexed parts were all examined with MRI before surgery, and all tumors were verified for schwannoma with pathyology. [ Result] In 38 cases, there were no function deficit and recurrence over a period of follow up from 6 months to 7 years in 36 cases. The partial intrinsic muscle palsy was present postoperatively in one case of the schwannomas in ulnar nerve with microsurgery of tumor, and recovered after 10 days. After the schwannoma in L4 nerves were cut off and the nerves was grafted, the myodynamia of quadriceps femoris were decreased two degree below, the treatment effect of nerve grafting were being followed up. [ Conclusion] （1） The technique of microsurgery was used under the microscopic operating, the tumors should be cut off for the most degree to decrease the recurrence possibility, remain the normal neuro-function. （2） The MRI examination should be carried out before the schwannoma operating in the complex pares of the crans, brachial plxus, lumbar plexus and etc. （3） All the schwannoma should be verified by pathyology after surgery.