影响多节段髓内良性肿瘤手术效果的相关因素分析

Analysis of factors affecting the outcomes after operation on multi-segments intramedullary spinal cord benign tumors

目的探讨患者性别、年龄、临床病程、肿瘤部位与性质和手术切除程度等对多节段髓内良性肿瘤手术效果的影响。方法总结54例多节段(3个椎体节段以上)髓内良性肿瘤患者的临床资料,患者均行后正中入路显微镜下肿瘤切除术。将二便功能状态分为4级[正常、尿频和(或)便秘等轻度异常、排便困难等中度异常、失禁],以改良JOA(IJOA)评分系统评价神经功能状况,以IJOA分值差(术后和术前IJOA差值)评估手术效果。患者随访4～76个月。以Logistic回归和多元线性回归分析统计学数据。结果临床病程(χ2=10.37,P=0.02)和肿瘤长径(χ2=19.58,P=0.02)是术前二便功能的有效影响因素。二便功能(t=-4.62,P=0.000)直接影响术前神经功能状况(IJOA值)。肿瘤长径(χ2=11.23,P=0.02)有效影响手术效果(IJOA分值差),瘤径较短患者术后神经功能一过性恶化,但术后2年内一般都会不同程度的恢复。结论肿瘤瘤体较长或病程较长会恶化患者的二便功能,间接影响患者术前的神经功能状态。应争取早期诊治多节段髓内良性肿瘤,避免神经功能的进一步恶化。

Objective To analyze retrospectively the clinical feature and histological nature of the patients with multi-segments intramedullary spinal cord benign tumors（MISCBTs）, and to evaluate the related factors affecting recent outcome after operation. Methods 54 patients with MISCBTs underwent the microsurgery of tumorectony using a posterior approach. The tumor was exposed through dorsal myelotomy. Preoperative and postoperative nervous functions were assessed using the Improved JOA （IJOA） grading system. Linear and Logistic regression analysis were performed to evaluate the relationship between functional outcome （IJOA score） and clinical course, histological features, gender, age, tumor location, remove extent, longitudinal extent of spinal cord involvement and preoperative nervous function. All patients were followed up until Jun. 30,2008. Results The clinical course of patients （X^2 = 10. 37,P= 0. 02）and the longitudinal extent of spinal cord involvement （X^2 = 19.58, P= 0. 02）were the most important factors for influencing the preoperative functions of bowel and bladder functions. Furthermore, the urine and stool function （t=- 4.62, P = 0. 000） directly affected preoperative nervous function （IJOA）. Finally, the longitudinal extent of spinal cord involvement （X^2= 11.23, P = 0.02）was the most important factor for influencing the recent surgical outcome （ represented by the difference of IJOA）. Although the patients with shorter intramedullary spinal cord benign tumors suffered transient aggravation after operation, the aggravated nervous functions would be recovered in the two years after operation. Conclusions The clinical course of patients and the longitudinal extent of spinal cord involvement are the most important factors for influencing the functions of urination and defecation and preoperative nervous function. As soon as the diagnosis of multi-segments intramedullary spinal cord benign tumors was identified,the tumor should be removed by microsurgical technique for a good prognosis.