显微手术治疗脊髓脊膜膨出的疗效及影响因素分析(附532例报告)

The curative effect and influence factor of myelomeningocel microsurgery treatment(report of 532 cases)

目的探讨脊髓脊膜膨出的显微外科疗效。方法选择532例脊髓脊膜膨出患者,均行神经系统检查及MRI检查。采用显微外科手术治疗,比较手术前后尿动力学、神经电生理及膀胱B超等检查结果。术后疗效按显效、有效、无效和加重进行评定。结果按Kirollos术中松解分级评定方法519例(97.6%)达到Ⅰ级,11例(2.0%)达到Ⅱ级,2例(0.4%)为Ⅲ级。手术近期疗效,显效81例(15.2%),有效321例(60.3%),无效125例(23.5%),加重5例(0.93%)。结论早期手术可避免患者严重残疾,MRI检查、尿动力学以及神经电生理、术中使用显微镜可提高脊髓拴系综合征的疗效。

Objective To discuss therapeutic effect of microsurgery treatment of myelomeningocel by analyzing the clinical data of 532 cases. Methods Examinations in nervous system and MRI were conducted. The microsurgical treatment of myelomeningocel was performed in all cases and the therapeutic effectiveness after operation was graded according to the physical improvement of the patients： excellent, effective, ineffective and aggravation. Results The degree of untethering at microsurgery which was based on Kirollos grading system was assessed： GradeⅠin 519 cases （97.6%）, GradeⅡ in 11 cases （2.0%）, GradeⅢin 2cases （0.4%）. Recent curative effectiveness in 532 patients was recorded, among them 81 cases（15.2%） excellent, 321 cases（60.3%） effective,125 cases（23.5%） not changed and 5 case（0.93%） aggravated. Conclusions The early standard surgery may avoid the patients’ serious disability. By clinical practice of MRI、dynamics as well as the neuroelectricity physiology, microsurgery may enhance curative effect of myelomeningocel greatly.