45例椎管内原发性肿瘤的外科治疗体会

The treatment of 45 cases with intraspinal tumors

目的:探讨椎管内肿瘤的临床诊断和手术治疗效果。方法:总结45例椎管内原发肿瘤患者的临床表现,影像学检查,手术方式及术后脊髓功能改善情况。结果:椎管内原发性肿瘤患者的临床表现为腰背痛、四肢感觉异常、运动和功能障碍。MRI检查为椎管内占位、脊髓受压征象。45例均已行手术治疗,35例肿瘤切除完整,10例大部分切除。术后均经病理证实为椎管内良性肿瘤,其中神经鞘瘤25例、神经纤维肿瘤10例、纤维脂肪肿瘤3例、脊膜瘤7例。有4例术前出现不完全截瘫,术后3例完全恢复,有1例遗留部分功能障碍,其它患者术后临床症状均有明显改善。结论:影像学检查对椎管内原发肿瘤有较高的检出率,MRI检查对明确病变性质和部位有重要意义,最终确诊依赖于病理诊断。椎管内原发肿瘤如能早期发现诊断和手术治疗,临床效果好。

Objective：To explore the clinical diagnosis of the intraspinal tumors and evaluate its therapentic effect. Mehthod ：45 of intraspinal tumors were retrospectively investigated from August 2000to April 2008. All characteristics of those cases were recorded and analyzed carefully,including the clinical manifestation, the image document, spinal cord or neural function and the surgical management. Result：Back pain, motor function damage,impairment of sensation and sphincter dysfunction were the most frequent complains. The MPI showed the vertebral canal compression. 45 patients all took the operation, complete excision was done in 35 cases, partial excision in 10 cases, All 45 cases were benign tumors and conferment by pathology , there were 25 neurinoma cases, 10 neurofibroma cases and 3 textile fiber fat tumor cases and 7 spinal meningioma cases. All patients achieved good recovery except 4 who got postoperative incomplete paraplysis （3 case achieved complete recovery, one case have some dysfunction）. Conclusion： The MPI is very important to make clear about the characteristics and position of the tumor. But the final diagnosis and opertation can be conducted.