660例椎管内肿瘤的手术治疗

Surgical Treatment of 660 Consecutive Cases of Spinal Cord Tumor

目的评价椎管内肿瘤的病理及手术治疗效果。方法回顾性分析1993年2月～2007年12月660例共676个椎管内肿瘤。肿瘤位于颈段231个,胸段202个,腰段159个,骶管内9个,16个位于颈胸段,42个位于胸腰段,17个位于腰-骶段间。共施行手术699次,其中后路经双侧椎板切除入路599次,经半椎板切除入路71次,经椎板成形术行肿瘤切除6次,经侧方入路行哑铃形肿瘤的椎管外部分切除23次。结果髓外肿瘤占76.5%(517/676),神经鞘瘤和脊膜瘤常见,全切除率92.3%(477/517)。髓内肿瘤占23.5%(159/676),以室管膜瘤和星形细胞瘤常见,全切除率67.3%(107/159)。围手术期死亡率1.7%(11/660)。出院时运动功能障碍77.8%(357/459)得以改善,感觉障碍改善率为79.2%(397/501),括约肌功能障碍改善率为72.4%(215/297),自发性疼痛93.3%(361/387)缓解或消失。582例平均随访时间5.9年(0.5～15.1年),87.8%(499/568)患者神经功能ASIA分级E级。结论椎管内肿瘤以髓外-硬膜下多见,神经鞘瘤及脊膜瘤居多。手术应在MRI影像基础上,制定出相应的微创手术治疗方案。总体椎管内肿瘤手术效果满意。

Objective The purpose of this study was to evaluate the outcome of surgical treatment for spinal cord tumors. Methods We retrospectively analyzed a series of 660 patients with 676 intra-spinal tumors who were treated surgically from February 1993 to December 2007. The tumors located at the cervical level in 231 patients, thoracic in 202, lumbar in 159, sacral in 9, cervieo-thoracic in 16, thoraeico-lumbar in 42, and lumbar-sacral in 17. Totally 699 operations were performed, including posterior bilateral laminectomy approach in 599, unilateral laminotomy in 71 and laminoplasty in 6 cases. Besides,23 additional operations via lateral or ventral-lateral were performed for resection of extra-spinal component of dumbbell shaped tumors. Results In this series, Schwannomas and meningiomas were the most common extramedullary tumors accounting for 76.5% of the cases [ 517/676, rate of total resection： 92.3% （477/517）]. The intra-medullary tumors accounted for 23. 5% （159/676） , in which astrocytomas and ependymomas were the most often observed [ rate of total resection： 67.3% （107/159）]. The peri-operative mortality was 1.7% （11/660）. The motor and sensory functions were found to be improved after operation in 77.8% （357/459） and 79.2% （397/501） respectively. The sphincter function was improved in 72.4% （215/297）. The rate of pain relief was 93.3% （361/387）. The follow- up periods ranged from 0.5 to 15.1 years in 582 patients with an average of 5.9 years; during the period, 87.8% （499/568） of the patients had an ASIA impairment scale E neurological function. Conclusions lntra-spinal tumors locate mostly in the subdural-extramedullary space, with a majority are Sehwannomas and meningiomas. The widespread application and availability of MRI investigation provide the physician with accurate localization of the lesion thereafter ensure a minimally invasive surgical treatment strategy keeping the stability of the spine while removing the tumors with an satisfactory outcome.