骶尾部脊髓脂肪瘤的手术技巧

Surgical techniques of sacrococcygeal spinal cord lipomas

目的介绍骶尾部脊髓脂肪瘤的病理解剖及相应的手术技巧。方法2005年9月至2012年1月，上海儿童医学中心手术治疗骶尾部脊髓脂肪瘤119例，年龄1个月至18岁，神经系统症状有大小便失禁和（或）双下肢功能障碍。手术方法包括：切除皮下和椎管内脊髓外的脂肪瘤，脊髓内的脂肪瘤大部分切除，将脊髓从两侧硬脊膜上剪开，圆锥从硬脊膜囊末端剪开并分离下来，松解脊髓栓系。结果骶尾部脊髓脂肪瘤主要病理解剖与腰骶部脊髓脂肪瘤相似，不同之处在于圆锥生长在末端硬膜囊上，圆锥发出的脊神经从圆锥腹侧斜向下方发出，脂肪瘤仅生长到脊髓内，并未生长到脊髓下方的脊神经内。108例得到随访，随访时间0．5—7．0年。术前有症状的患儿，术后多数有不同程度改善，1例症状加重，6例术后症状一过性加重；10例无症状者术后9例仍然无症状，1例症状一过性加重。结论只有充分认识骶尾部脊髓脂肪瘤病理解剖，才能最大限度地切除脂肪瘤，彻底解除脊髓栓系，同时又能避免神经损伤，重建脊髓的正常解剖结构，最大限度恢复神经功能。

Objective To introduce the pathological anatomies and surgical techniques of sacrocoecygeal spinal cord lipomas. Methods Data was collected on 119 patients with sacrococeygeal spinal cord lipomas at Shanghai Children＇s Medical Center from September 2005 to January 2012, ages 1 month to 18 years, whose neurological symptoms included incontinence of urine and stool and/or malfunction of the lower extremities. The surgical procedures consisted of the excision of subcutaneous and intradural extramedullary lipoma, partial excision of the intramedullary lipoma, detachment of the spinal cord from the dural membrane, freeing the conus medullaris from the end of the dura sac, and relief of the tethered spinal cord. Results The main pathological changes of sacrococcygeal spinal cord lipomas were similar to those of the lumbosacral ones. The differences included that the conus medullaris growed with the end of dura sac, the spinal nerves of the conus medullaris originated from its ventral part and ran obliquely and inferiorly, the lipoma is located within the conus medullaris and beyond the spinal nerves below the conus medullaris. 108 cases were followed up for 0. 5 to 7.0 years. Improvement after surgery varied amongst the symptomatic patients. The symptoms in 1 case worsened after surgery, transient deterioration of symptoms after surgery were seen in 6 cases, 9 out of 10 asymptomatic patients remained asymptomatic while the rest showed transient deterioration of symptoms. Conclusions We could optimally excise the lipoma, untether the spinal cord and avoid damage to the spinal nerves, reconstruct the normal anatomy of the spinal cord, and rehabilitate neurological functions with the thorough understanding of the pathology of the saerococcygeal soinal cord linomas.