周围神经束间瘤变组织显微切除治疗周围神经脂肪纤维瘤

Microsurgical resection of intrafascicular neoplastic tissue for treatment of peripheral nerve lipofibroma

目的探讨周围神经脂肪纤维瘤的诊治方法。方法2005年1月至2010年7月，收治周围神经脂肪纤维瘤患者5例，其中单纯正中神经瘤变3例、正中神经合并尺神经瘤变2例、合并巨指1例，采用周围神经松解、瘤段切除、周围神经束间瘤变组织显微切除等手术治疗。结果术后随访7～24个月，行瘤段病变切除1例术后出现神经支配区感觉缺失；行周围神经松解2例，术后手指麻木症状消失；行周围神经束间显微切除2例，无明显神经支配区感觉缺失。结论通过CT、脚、手术观察以及术后肿瘤病理检查可明确诊断周围神经脂肪纤维瘤，但目前治疗手段有限，周围神经束间瘤变组织显微切除是一种在最大限度保存神经功能的前提下可切除较多瘤变组织的治疗方法。

Objective To investigate the diagnosis and treatment of lipofibromas of the peripheral nerve. Methods From January 2005 to July 2010, 5 cases of peripheral nerve lipofibroma were treated. There were 3 cases of median nerve neoplasia alone, 2 cases of combined median and ulnar nerve neoplasia, and 1 case of combined macrodactyly. Neurolysis, tumor segment resection, intrafascicular neoplastic tissue resection were done under surgical microscope. Results Postoperative follow-up duration ranged from 7 to 24 months. Sensory loss was noted in 1 patient who had tumor segment resection, In 2 cases treated with neurolysis finger numbness disappeared after the surgery. No obvious sensory loss was observed in 2 cases treated with intrafaseicular neoplastic tissue resection. Conclusion CT, MRI, surgical observation and postoperative pathologic examination can confirm the diagnosis of peripheral nerve llpofibroma. Among the limited treatment options, intrafascicular neoplastic tissue resection is a procedure that maximizes the preservation of neurological function while removing as much neoplastic tissue as possible.