颈胸段椎管内脂肪瘤分类及手术治疗

Clinical classification and surgical management of cervicothoracic intraspinal lipomas

目的 探讨颈胸段椎管内脂肪瘤的分类及手术治疗策略.方法 回顾性分析北京天坛医院2009年1月至2012年10月22例经病理学证实的颈胸段椎管内脂肪瘤患者的临床资料.结果 全切除4例,近全切除7例,大部切除11例;采用改良的McCormick神经功能分级评估神经功能,术后3个月随访结果显示：改善16例,平稳3例,加重3例;长期随访（＞12个月）,除4例病情加重外,其他均比术前有改善;颈胸段脂肪瘤可分为硬膜外型,移行型,嵌合型和继发性髓内型脂肪瘤4类.结论 不同类型的颈胸段椎管内脂肪瘤手术切除程度与效果不一.硬膜外型脂肪瘤,可全切除,预后最好;移行型脂肪瘤,以减压为目的,慎重全切除;嵌合型与继发性髓内型脂肪瘤,手术的目的是最大安全切除,避免由于术中操作导致的功能缺失.术中使用激光技术易于切除肿瘤,加强术中电生理监测有利于保护脊髓功能.

Objective To explore the clinical classification and surgical management of cervicothoracic intraspinal lipomas.Methods A total of 22 patients with cervicothoracic intraspinal lipomas were analyzed retrospectively with regards to clinical manifestations,radiographic features,intraoperative findings,surgical techniques and follow-ups.Results Total （n =4）,subtotal （n =7） and partial （n =11） resection was performed.Long-term neurological outcomes were evaluated by modified McCormick classification scheme.Their symptoms improved （n =15）,unchanged （n =3） and deteriorated （n =4）.And cervicothoracic intraspinal lipomas could be classified into extradural,transitional,chaotic and secondary intramedullary groups.Conclusion Different groups of cervicothoracic intraspinal lipomas vary in the degree of resection and surgical efficacy.Total resection may be performed on most extradural lipomas.The surgical objective of transitional lipomas is decompression.Chaotic and secondary intramedullary lipomas should target effective resection to avoid neurological function injury.Intraoperative use of laser facilitates tumor resection.Intraoperative electrophysiological monitoring protects spinal cord.