椎管内外沟通性肿瘤手术治疗方法和临床疗效评价

Surgical treatment and clinical effect analysis of intra-and extra-spine tumors

目的探讨临床中不同节段椎管内外沟通性肿瘤手术治疗方法和临床疗效评价。方法回顾性分析2015年1月至2018年10月在延安市人民医院神经外科住院经显微手术切除的16例椎管内外沟通性肿瘤患者的临床资料。术前均完善脊柱X线、CT三维重建、MRI(平扫+增强)检查,明确肿瘤大小、位置及其周围组织的解剖关系,对于颈段的肿瘤,术前还需行颈部血管CTA检查评估肿瘤与椎动脉之间的关系,有利于指导术中肿瘤完整切除和避免损伤椎动脉。手术方式采取后正中入路暴露病变椎体节段、显微镜下一期完整切除肿瘤,其中14例采用钉棒系统内固术重建脊柱的稳定性。术后行脊柱CT三维重建和X线检查评价脊柱稳定性,行MRI检查评价肿瘤的切除情况,对手术前后感觉、运动障碍恢复情况,采用美国脊髓损伤学会(ASIA)评分进行统计学分析评估。结果本组16例椎管沟通性肿瘤均在显微镜下行一期全部切除。术后无一例脑脊液漏、切口感染及死亡病例发生。术后随访3月~2年,16例患者术后神经功能恢复均有不同程度的改善,影像检查随访均无肿瘤复发及脊柱失稳。结论对于椎管内外沟通性肿瘤选择显微镜下手术一期全切肿瘤,同时行脊柱内固定术维持术后脊柱稳定性,具有较好的临床疗效。

Objective To investigate the surgical technique and clinical effect of intra-and extra-spinal tumors in different segments.Methods The clinical data of 16 patients with intramedullary and intramedullary communicating tumors in the spinal canal who were admitted to the department of neurosurgery of Yan'an people's hospital from January 2015 to October 2018 were retrospectively analyzed.Preoperative are perfect spine X-ray,CT three-dimensional reconstruction and MRI(scan+enhanced),tumor size,location and the surrounding tissue anatomy relationship,for tumor of neck,preoperative need line neck vascular CTA evaluation of tumor and the relationship of the vertebral artery,beneficial to guiding intraoperative complete tumor resection and avoid vertebral artery injury.The tumor was completely resected by the posterior midline approach with the exposure of the diseased vertebral segments and the complete resection under the microscope in the first stage,among which 14 patients underwent the screw and rod system internal fixation to reconstruct the stability of the spine.After the surgery,three-dimensional spinal CT reconstruction and X-ray examination were performed to evaluate the stability of the spine,and MRI examination was performed to evaluate the resection of the tumor.Results All 16 cases of spinal canal communication tumors were excised under microscope.No cerebrospinal fluid leakage,incision infection and death occurred.Postoperative follow-up was conducted for 3 months to 2 years.All the 16 patients showed different degrees of improvement in postoperative neurological function.No tumor recurrence and spinal instability were found in the imaging follow-up.Conclusion It is of good clinical effect to choose one stage total resection for intraspinal and intraspinal communicating tumors under microscope and to maintain the stability of the spine by spinal internal fixation.