脂肪脊髓脊膜膨出的手术治疗

Surgical treatment of lipomyelomeningocele

目的探讨脂肪脊髓脊膜膨出(LMM)的手术疗效。方法回顾性分析20例LMM病人的临床资料,术前Hoffman 0级17例,1级1例,2级2例。疗效评价:术后Hoffman分级较术前降低或无变化为有效,升高为恶化。按Kirollos和Hille术中栓系松解分级评定法评定栓系松解程度。结果 20例随访6～36个月,平均27.6个月。一级松解11例,二级松解9例。Hoffman 0级6例,1级1例,2级12例,4级1例;本组治疗有效11例(55%),恶化9例(45%)。无严重并发症发生。结论 LMM的手术治疗应综合考虑手术时机、脂肪瘤切除程度、神经栓系松解程度、手术疗效的评估手段和术后随访等,从而提高手术疗效。

Objective To investigate the effect of surgical treatment for lipomyelomeningocele（LMM）. Methods Clinical data of 20 LMM patients were analyzed retrospectively, including Hoffman grade 0 in 17 patients, grade 1 in 1 and grade 2 in 2. The surgical outcome was evaluated as follows： compared with preoperation, reduction or no change of Hoffman classification was considered effective, and increase of the classification deteriorative. The untethering degree of tethered system during the operation was evaluated by Kirollos and Hille technique. Results Twenty patients were followed up for mean time of 27.6 months, ranging from 6 to 36 months.Untethering grade one was achieved in 11 patients and grade two in 9 according to Kirollos and Hille technique. There were 6 patients with Hoffman grade 0, 1 with grade 1, 12 with grade 2 and 1 with grade 4 after the operation. The response rate was 55%（11/20 patients）, and deterioration was seen in 9 patients（45%）. No serious complications occurred. Conclusions The surgical treatment of LMM should be comprehensively considered of various factors, including surgical timing, the extent of tumor excision, untethering degree of tethered nerve, assessment of surgical outcome, postoperative follow-up and so on for improving surgical outcome.