原发性胸腰段椎管内肿瘤漏诊、误诊19例临床分析

Clinical analysis of primary thoracic and lumbar intraspinal tumors misdiagnosed as lumbar intervertebral disc herniation: report of 19 cases

目的分析椎管内肿瘤漏诊的原因,以降低临床漏诊、误诊率。方法回顾性分析19例被漏诊的椎管内肿瘤患者的临床资料,分析发生漏诊的原因,提出避免措施。结果 19例患者均在院外有不同程度的误诊、误治,遂到我院进行治疗,均经全脊柱MRI检查明确椎管内肿瘤后行手术治疗。术后病理结果显示,神经鞘瘤13例,脊膜瘤3例,室管膜瘤2例,血管平滑肌脂肪瘤1例。术后随访时间1-36个月,19例疼痛均明显缓解,18例恢复正常工作及生活,1例残留左臀及左小腿外侧麻木,无死亡及复发病例。结论椎管内肿瘤的早期症状和腰椎间盘突出的临床特征虽有相似之处,但只要进行详细的病史采集和仔细的体格检查,选择恰当的影像学检查,两者是可以鉴别而避免漏诊、误诊的。

Objective To analyze the misdiagnosis causes of intraspinal tumors misdiagnosed as lumbar intervertebral disc herniation,and reduce the clinical rate of misdiagnosis. Methods Clinical data of19 patients with intraspinal tumors misdiagnosed as lumbar intervertebral disc herniation were retrospectively analyzed,and the respective characteristics,essentials for diagnosis and differential diagnosis of the 2 kinds of diseases were summarized. The misdiagnosis causes were analyzed, and prevention measures were put forward. Results All the misdiagnosed patients performed MRI scanning,and then received operative treatment. Histological diagnosis results showed that there were 13 cases of schwannomas,3 cases of meningiomas,2 cases of ependymomas,and 1 case of angiomyolipoma. In 1 - 36 months＇ follow-up,pain of all the patients was alleviated. Eighteen patients were healed,and only one patient still had numbness at left hip and left leg. No patient reoccurred or died. Conclusion Though there are similarities in early clinical manifestations between intraspinal tumors and lumbar intervertebral disc herniation,the two kinds of diseases can be identified to avoid misdiagnosis through collecting the detailed history,performing careful physical examination,and choosing the appropriate imaging examination.