高颈段椎管内肿瘤患者显微外科手术治疗效果研究

Microsurgical Treatment of High Cervical Spinal Canal Tumors

目的 分析高颈段椎管内肿瘤患者显微手术治疗效果及预后状况。方法 回顾性分析接受显微手术治疗高颈段椎管肿瘤患者98例,分析患者临床症状、影像学特征及手术效果,术前和末次随访,使用日常生活能力(ADL)量表评价其预后状况。结果 98例患者中41例为神经鞘瘤、1例为血管外皮瘤、26例为脊膜瘤、1例为转移瘤、19例为室管膜瘤、1例为神经纤维瘤、2例为星形细胞瘤、2例为淋巴瘤、1例为海绵状血管瘤、2例为血管母细胞瘤、2例为脂肪瘤;98例患者中90例肿瘤全切除,8例因肿瘤和脊髓分界不清、粘连紧密行次全切除。术后有9例患者发生并发症,其中2例为脑脊液漏,2例为手术区渗液、切口愈合不良,4例为椎管内无菌性炎症,还有1例星形细胞瘤术后发生肺部感染,手术前突发循环、呼吸变化,急诊手术治疗,术后没有自主呼吸,需要呼吸机辅助呼吸,产生坠积性肺炎,最后因循环、呼吸衰竭死亡。结论 高颈段椎管肿瘤患者使用神经显微镜技术切除效果较好,可减低神经受损并发症,为保持颈椎稳定性方面,需依据占位和脊髓位置选择手术方式。

Objective The microsurgical treatment and prognosis of patients with high cervical spinal canal tumor were analyzed. Methods Retrospective analysis of 98 patients with high cervical spinal canal tumor treated by microsurgery,analysis of clinical symptoms,imaging features and surgical results,preoperative and last follow-up,using the daily life ability (ADL) scale to evaluate the prognosis. Results Of the 98 patients,41 were schwannomas,1 was hemangiopericytoma,26 were meningioma,1 was metastatic tumor,19 was ependymoma,1 was neurofibroma,2 were star shaped cell tumor,2 cases of lymphoma,1 case of cavernous hemangioma,2 cases hemangioblastoma,lipoma 2 cases;98 patients,90 cases of tumor resection,but 8 of the spinal cord tumor boundaries and do not clear,close adhesion subtotal resection.9 patients after surgery complications,including 2 cases of leakage of cerebrospinal fluid,exudate region 2 cases surgery,wound healing,4 cases of spinal inflammation,as well as astrocytomas 1 patient pulmonary infection,burst cycles before surgery,changes in breathing,emergency surgery,postoperative no spontaneous breathing,need mechanical ventilation,resulting hypostatic pneumonia,and finally due to circulatory,respiratory failure and death. Conclusion High cervical vertebrae neural tumors excised better microscopic techniques,can reduce the complications,nerve damage,cervical aspect to maintain stability,must be selected according to surgical approach and occupying the position of the spinal cord.