显微荷包缝合及带蒂脂肪填塞治疗症状性骶管囊肿的初步探讨

Preliminary treatment of microscopic purse - string suture and pedicle fat tamponade in symptomatic sacral canal cyst

目的探讨症状性骶管囊肿的显微手术治疗方式。方法18例症状性骶管囊肿按分类采用不同手术方式。按照有无交通孔分为神经周围囊肿、神经根袖扩张两种，后者又分为单纯交通型和神经根袖型。神经周围囊肿在保护神经根前提下囊肿壁大部分切除或全切除；单纯交通型交通孔根部荷包缝合收紧；神经根袖型交通孔处脂肪垫保护荷包缝合，适度收紧，残留神经袖套塑形重建。残腔均用带蒂脂肪填塞。结果18例术后随访6—36个月（平均18个月），囊肿未见复发。术后16例症状改善，2例仍存在疼痛及麻木不适感，不影响生活及工作。结论症状性骶管囊肿应根据囊肿不同类型行显微手术治疗。在保护神经的前提下切除囊肿，交通孔处荷包缝合，神经袖套塑形重建，带蒂脂肪填塞残腔。此手术方式安全、效果好，复发率低。

Objective To explore the clinical features and microsurgical treatment of symptomatic sacral canal cyst. Methods 18 cases with symptomatic sacral canal cyst were operated through different surgical modes according to the classifications. According to the relationship with communicating foramen, these cysts were divided into two types ： perineural cyst and nerve root sleeve expansion. While the latter was divided into two subtypes： simple communicating and the sleeve of the nerve root. For perineural cyst, we performed subtotal or total resection of the cyst wall under the protection of nerve roots. For the simple communicating cyst,we performed purse - string suture in the neck of cyst. For the cyst with sleeve of the nerve root,we performed partial cyst excision, plication of the cyst wall, purse - string suture in the neck of cyst and remodel the sleeve of the nerve root. The residual cavity area was tamped by a fascial fat with pedicle. Results 18 patients were followed -up for 6 -36 months （ an average of 18 months） and there was no cyst recurrence. 16 out of 18 patients experienced complete or substantial resolution of the preoperative local and radicular pain. Two patients still complained of mildly pain and numbness but could be tolerated without influence on their daily life. Conclusions Microsurgical treatment should be selected for patients with symptomatic sacral canal cysts according to the different types of cysts, including total or partial cyst excision combined with direct dural closure , purse - string suture in the neck of cyst, remodeling the sleeve of the nerve root and pedicled fat filling the cavity under the protection of nerve roots. Effective and safe treatment of symptomatic sacral canal cyst with low recurrence could be achieved.