显微手术治疗脊髓室管膜瘤

Microsurgery for spinal intramedullary ependymomas

目的:探讨脊髓室管膜瘤显微手术治疗中的相关问题,并评估其手术疗效及预后。方法:2005年10月至2007年10月我院收治36例脊髓室管膜瘤患者,男性27例,女性9例;年龄16～59岁,平均41.2岁。运动异常28例,感觉障碍20例,神经根性痛和局部疼痛16例,括约肌功能障碍6例。MRI检查病灶呈等信号或略高信号,多无明显强化,边界较清楚,部分伴有空洞。术前McCormick临床功能分级:Ⅰ级16例,Ⅱ级11例,Ⅲ级9例。肿瘤主体位于颈段23例,颈胸交界区6例,胸段4例,腰段3例。均在显微镜下分离切除肿瘤实质部分。结果:肿瘤全切除32例,次全切除4例,次全切患者术后接受放射治疗,无手术死亡。术后发生肺炎5例,脑脊液漏3例,手术切口感染1例,经对症治疗后痊愈。术后病理证实均为室管膜瘤。31例获得为期1年的随访,3例肿瘤次全切除患者1年内复发,再次行手术治疗;肿瘤全切除者无复发。术后McCormick临床功能分级:Ⅰ级23例,Ⅱ级6例,Ⅲ级2例。结论:显微手术是治疗脊髓髓内肿瘤的有效手段。肿瘤能否全切主要取决于肿瘤与脊髓的粘连程度和手术技巧。

Objective：To investigate the questions related to microsurgery for spinal intramedullary ependymomas and evaluate the surgical results and prognosis.Method：From October 2005 to Octorber 2007,36 patients with spinal intramedullary ependymomas underwent micmsurgery were analysed retrospectively.There were 27 males and 9 females with an average age of 41.2 years（range from 16 to 59 years）.Motion abnormality was in 28 cases,sensory disturbances was in 20 cases,nerve pain and local pain were in 16 cases,and sphincter dysfunction was in 6 cases.The lesions on MRI showed equal or slightly higher signal,without apparent enhancement,boundary more clearly,and some accompanied by syringomyelia.Preoperative neurological status was evaluated by McCormick grading scale,grade Ⅰ in 16 cases,grade Ⅱ in 11 cases,grade Ⅲ in 9 cases.The location of tumor was as follows,23 were in the cervical spinal cord,6 in the cervicothoracic spinal cord,4 in the thoracic spinal cord and 3 in the lumbar spinal cord.The...更多 tumor was romoved by the surgical treatment under microscope.Result：Total removal of tumors was achieved in 32 patients,and subtotal in 4 patients,who were treated with radiotherapy subsequently.There was no death during the operation.Surgical complications included pneumonia in 5 cases,cerebrospinal fluid leakage in 3 cases and wound infection in 1 case,all were resolved by adminstration of antibiotics or continuous lumbar subarachnoid cerebrospinal fluid drainage.The ependymoma was confirmed by postoperative pathology.McCormick grading scale：grade Ⅰ in 23 cases,grade Ⅱ 16 cases,grade Ⅲ 2 cases.31 cases were followed-up for a year after operation.Three cases with subtotal resection relapsed and had been re-operated within 1 year.Conclusion：Microsurgery is an effective method to treat intramedullary spinal cord tumors.Whether the tumor can be totally removed or not mainly depends on the conditions of tumor adhesion to spinal cord and microsurgical skills of the surgeons.