预防性手术治疗儿童无症状脊髓脂肪瘤

Prophylactic operation for asymptomatic spinal lipomas in children

目的探讨预防性手术治疗儿童无症状脊髓脂肪瘤的临床效果及意义。方法回顾性分析2001年4月至2015年6月上海交通大学医学院附属上海儿童医学中心神经外科采取预防性手术治疗168例无症状脊髓脂肪瘤患儿的临床资料。患儿手术年龄为1.5个月至15.0岁(中位年龄为7个月),术前均无疼痛、大小便失禁和(或)双下肢功能障碍等神经系统症状。手术方法包括:切除皮下和椎管内脊髓外的脂肪瘤以及脊髓内的脂肪次全切除,并将脊髓包括末端圆锥从硬脊膜囊上剪开并分离,以松解脊髓拴系。结果168例患儿中,132例脊髓背侧型脂肪瘤均全切除,36例方型及包绕型脂肪瘤次全切除。5例术后出现脑脊液漏致皮下积液,经多次穿刺抽液并加压包扎后治愈。6例术后即刻出现大小便轻度失禁,其中5例1个月内完全恢复正常,1例症状持续无缓解。168例患儿中,159例获随访,随访时间为3~19年(中位随访时间为76个月)。13例(8.2%)术后远期出现症状,其中12例为脊髓粘连,1例为脊髓脂肪瘤复发。结论对于儿童无症状脊髓脂肪瘤,预防性手术治疗能够减少患儿日后神经功能障碍的发生。

Objective To explore the clinical outcome and value of prophylactic operation of asymptomatic spinal lipomas in children. Methods We retrospectively analyzed the clinical data of 168 patients with asymptomatic spinal lipomas who underwent prophylactic operation from April 2001 to June 2015 at Department of Neurosurgery, Shanghai Children s Medical Center, School of Medicine, Shanghai Jiaotong University. Those patients (with an average age of 7 months) aged from 1.5 months to 15 years old were free of preoperative symptoms such as pain, gatism and/or bilateral lower limb dysfunction. Surgical protocols included removal of the lipomas in subcutaneous and extramedullary tissues, complete excision of extraspinal lipomas, subtotal resection of intraspinal fat, detaching of the medullary cones from dura sac and release of the tethered cord. Results In 168 patients, complete resection was achieved for the dorsal spinal lipoma ( 132 patients) and subtotal resection was undertaken for the lateral type and the wrapped lipoma(36 patients). Five cases developed cerebrospinal fluid leakage that caused subcutaneous effusion after surgery, which resolved following multiple punctures and pressure dressing. Six patients had slight gatism. Among them, 5 recovered in 1 month and 1 had no relief of symptoms. In this series, 159 out of 168 cases were successfully followed up for 3 - 19 years ( with an average of 76 months). Long-term postoperative symptoms were observed in 13 patients, with an incidence of 8. 2%. Twelve patients of them had spinal cord retethering and 1 had lipoma enlargement. Conclusion Prophylactic surgery could lead to favorable outcomes in children with asymptomatic spinal lipomas and help prevent neurologic dysfunction in the future.