摘要
目的探讨腰骶部脂肪瘤合并脊髓栓系综合征的分类和显微手术治疗效果。方法回顾性分析哈尔滨医科大学第一附属医院神经外科2008年5月至2011年7月收治的39例腰骶部脂肪瘤合并脊髓栓系综合征患儿,术前均行MRI等影像学检查,根据影像学特点结合术中解剖学特点分为背侧型、硬膜内外沟通过渡型、腹背侧混合杂乱型三类。所有患者均在全麻下行显微镜下脂肪瘤切除+脊髓神经松解+终丝切断术,通过对患儿术前1周、术后3个月Hoffman功能分级,进行治疗效果的对比。结果 39例患儿术后全部得到随访,平均15个月,没有死亡病例,其中12例背侧型脂肪瘤和18例硬膜内外沟通过渡型脂肪瘤患儿术后症状明显改善或者稳定,无神经功能缺失加重病例,疗效满意。其中9例腹背侧混合杂乱型脂肪瘤大部分患儿术后症状较术前有所改善或者稳定,但其中2例患儿大小便失禁加重。术后2例发生切口脑脊液漏,1例硬膜内外沟通过渡型,1例腹背侧混合杂乱型,均经过严格的抗炎治疗后切口痊愈。结论对于腰骶部背侧型脂肪瘤和硬膜内外沟通过渡型脂肪瘤无论早期有无神经功能缺失,都主张尽早行显微镜下脂肪瘤切除+脊髓神经松解+终丝切断术;腹背侧混合杂乱型脂肪瘤局部解剖复杂,术中难以完全辨认马尾神经和终丝,术后症状改善不理想,并发症较多,对于早期手术应慎重考虑。
Objective To investigate the classification and microsurgical treatment effect of the combined lumbosacral lipoma with tethered cord syndrome. Methods A retrospective analysis of 39 children patients suffered from lumbosacral lipoma and tethered spinal cord disease in neurosurgery department of the First Affiliated Hospital of Harbin Medical University from May 2008 to July 2011 was performed. According to the preoperative MRI features and intraoperative anatomy characteristics, the patients were divided into the dorsal, transitional, and chaotic lipomas. Under general anesthesia, the microscope lipoma resection and spinal neurolysis cut wire surgery were performed. The children Hoffman functional classification were carried out at one week before surgery and three months after surgery to compare the treatment effects. Results All 39 patients were followed up, with an average of fifteen months, no deaths, 12 cases of dorsal lipomas and 18 transitional lipomas were improved or stable after surgery, no neurological deficit increase,the results were satisfactory. 9 chatic lipomas were improved or stable after surgery compared with preoperative symptoms, but 2 patients' incontinence got worse. Two cases occurred cerebrospinal fluid leakage postoperative ,one transitional case and one chaotic case, were subject to stringent anti-inflammatory treatment to be healed. Conclusions For the lumbosacral dosal and transitional lipoma either with or without neurological deficit early, as early as possible under the microscope have advocate resection of spinal cord lipoma release the final wire off the surgery;but for the chaotic lipomas, surgery are difficult to fully identify the cauda equina and ilium terminale, the symptoms impoved after surgery is not ideal, more compilications, early operation should be carefully considered.
出处
《中华临床医师杂志(电子版)》
CAS
2012年第2期33-36,共4页
Chinese Journal of Clinicians(Electronic Edition)