半椎板切除显微手术治疗椎管内肿瘤的临床研究

Clinical study of semi-laminectomy microsurgery in the treatment of intraspinal tumors

目的探讨半椎板切除显微手术治疗椎管内肿瘤的临床疗效及优点。方法 176例术前经MRI确诊并经术后病理证实的椎管内肿瘤患者按照随机数字法分为半椎板切除显微手术组(n=88)和全椎板切除术组(n=88),分别行半椎板切除显微手术或全椎板切除术切除肿瘤,比较两组患者手术时间、术中出血量、肿瘤完全切除率、术后平均住院时间及临床症状改善情况,评价术后6个月的脊柱稳定性,并观察术后并发症发生情况。结果半椎板切除显微手术组手术时间及平均住院时间均短于全椎板切除术组(t=7.53,P<0.01;t=4.88,P<0.05);术中出血量少于全椎板切除术组(t=11.28,P<0.01);术中肿瘤完全切除率略高于全椎板切除术组,但差异无统计学意义(χ2=0.96,P>0.05)。半椎板切除显微手术组出院时临床症状改善率略高于全椎板切除术组,但差异无统计学意义(χ2=1.22,P>0.05)。半椎板切除显微手术组88例均脊柱稳定性良好,全椎板切除术组11例出现脊柱不稳定(χ2=4.60,P<0.05)。半椎板切除显微手术组术后1例发生脑脊液漏,3例发生感染;全椎板切除术组2例出现局部疼痛,1例肌肉无力,3例脊柱后突畸形。结论半椎板切除显微手术治疗椎管内肿瘤创伤小,手术及住院时间短,术中出血少,疗效确切,能最大限度地维持术后脊柱的稳定性,值得临床推广应用。

Objective To explore the clinical efficacy and advantages of semi-laminectomy microsurgery in the treatment of intraspinal tumors.Methods A total of 176 patients with intraspinal tumors diagnosed by preoperative MRI and confirmed by pathology after surgery were randomly divided into semi-laminectomy microsurgical group（n = 88） and laminectomy group（n = 88）,and the patients were received semi-laminectomy microsurgery or laminectomy treatment respectively.The operation time,amount of perioperative blood,total resection rate,average postoperative hospital stay and improvement of clinical symptoms of the two groups were compared,the spinal stabilization after 6 months was evaluated,and the postoperative complications were also observed.Results The operation time and average hospital stays of the semi-laminectomy microsurgical group were statistically shorter than those of the laminectomy group（t = 7.53,P 0.01;t = 4.88,P 0.05）;the amount of perioperative blood was also less than that of the laminectomy group（t = 11.28,P 0.01）;the total resection rate was higher than that of laminectomy group,but there was no statistical difference（χ2 = 0.96,P 0.05）;the improvement rate of clinical symptoms was higher than that of the laminectomy group,but no statistical difference was observed（χ2 = 1.22,P 0.05）.All the 88 patients achieved good spinal stabilization after surgery in semi-laminectomy microsurgical group,and 11 patients occurred unstable spine after surgery in the laminectomy group（χ2 = 4.60,P 0.05）.1 patient occurred leakage of cerebrospinal fluid and 3 cases occurred infection after surgery in the semi-laminectomy microsurgical group;2 cases occurred local ache,1 case occurred muscle weakness,3 cases occurred kyphosis in laminectomy group after surgery.Conclusion semi-laminectomy microsurgery in the treatment of intraspinal tumors has advantages of small wound,shorten operation time and hospital stay,less amount of perioperative blood and good clinical efficacy,it can sustain spinal stabilization to the utmost,thus it is worthy of extensively application in clinic.