椎管内肿瘤的诊断与显微外科治疗

Diagnosis and microsurgical treatment of intraspinal tumors

目的探讨椎管内肿瘤的诊断及显微外科治疗技术。方法回顾性分析112例经MRI检查、有明确病理诊断的椎管内肿瘤的诊断及治疗结果。结果神经鞘瘤47例(42.0%),脊膜瘤21例(18.7%),星形细胞瘤9例(8.0%),室管膜瘤8例(7.1%),表皮样囊肿和皮样囊肿各2例(1.8%),脂肪瘤和血管瘤各5例(4.5%),转移瘤3例(2.7%),蛛网膜囊肿7例(6.3%),另有其它少见的神经节细胞瘤、结核瘤和囊虫病各1例。其中颈段肿瘤占29.5%,胸段占48.2%,腰段占14.3%,骶段占8.0%。肿瘤全切除率82.1%,其中髓外肿瘤全切除率达94.3%,髓内肿瘤全切除率40.0%。术后86.6%的病例症状有不同程度的改善,其中疼痛症状缓解最明显。有9.8%的病例症状较术前无变化,另有3.5%的病例术后症状加重。结论椎管内肿瘤大多为良性,手术效果好。MRI检查及显微外科技术的熟练应用是保证疗效的关键。尽可能以微创方法保持脊柱的稳定性非常必要。

Objective To explore the diagnosis and microsurgical treatment of the intraspinal tumors.Methods The pathological types,location,symptoms and signs,imaging examination and the surgical treatment of 112 cases of intraspinal tumors were analyzed retrospectively.Results Among 112 cases of intraspinal tumors,there were 47 cases（42.0%） of neurinoma,21 cases（18.7%） of meningioma,9 cases（8.0 %） of astrocytoma,8 cases（7.1%） of ependymoma,2 cases of epidermoid cyst（1.8%）,2 cases of dermoid cyst（1.8%）,5 cases of lipoma（4.5%）,5 cases of hemangioma（4.5%）,3 cases of（2.7%） metastasis tumor,7 cases（6.3%） of arachnoid cyst,and ganglioneuroma,phymatiosis,cysticercosis,with 1 case in each.According to the location,29.5% of tumors involved cervical region,48.2 % of thoracic region,14.3 % of lumbar region and 8.0% of sacral segments.The total removal rate was 82.1%,including 94.3% for extramedullary tumors and 40.0 % for intramedullary tumors,respectively.The post-operative improvement rate of symptoms was 86.6% and pain got the best relief.No post-operative improvement of symptoms occurred in 9.8% of cases,and worsened in 3.5% of cases.Conclusion The surgical outcome of intraspinal tumors,usually benign tumors,is good.MRI and skilled microsurgical techniques are the keys for good surgical outcome.It is also crucial to maintain the stability of spinal cord.