经通道微创手术切除腰椎神经鞘瘤与传统椎板切除术式的对比

Comparison between minimally invasive surgery and traditional laminectomy in the resection of schwannoma of lumbar vertebra

目的探讨经通道微创手术切除腰椎神经鞘瘤的应用及优缺点。方法本研究是一项前瞻性非随机对照研究,设置试验组(经通道微创手术组)和对照组(传统椎板切除手术组)。针对2017年12月至2019年3月在北京天坛医院神经外科脊髓脊柱病房住院治疗的腰椎神经鞘瘤患者,由手术医生与其进行一对一沟通告知经通道微创手术与传统椎板切除手术各自的优缺点。在明确手术风险及各自优缺点后,按照患者意愿,同意经通道微创手术切除肿瘤的患者纳入试验组(15例),否则以传统椎板切除方式进行手术并纳入对照组(15例)。分析两组患者相关临床资料,包括术前病变影像特点、术中出血量、手术操作时间、术后住院时间、术后并发症及症状改善情况等。结果试验组与对照组手术时间分别为(157±27)min和(158±29)min,P=0.897;术中失血量分别为(66±27)ml和(110±43)ml,P=0.020;住院时间分别为(7.60±1.29)d和(11.67±1.23)d,P=0.000;术后日本骨科协会评估治疗分数分别为26.73±2.84和26.60±2.41,P=0.891;术后视觉模拟评分分别为0.40±1.12和0.27±0.71,P=0.699。结论在一定类型的腰椎神经鞘瘤(非巨大肿瘤)中,经通道微创手术切除肿瘤具有手术创伤小、出血少、恢复快及疗效肯定的优点,是一种安全有效的手术治疗方法。

Objective To explore the application,advantages and disadvantages of minimally invasive surgery for lumbar schwannoma.Methods this study was a prospective,non-randomized controlled study with a trial group(minimally invasive surgery group)and a control group(traditional laminectomy group).For the patients with lumbar schwannoma hospitalized in the neurosurgical spinal ward of Beijing Tian Tan hospital,the surgeon communicated with them one-on-one to inform the patients of the advantages and disadvantages of minimally invasive surgery through channels and traditional laminectomy.After the surgical risks and their respective advantages and disadvantages were identified,patients who underwent minimally invasive surgery to remove tumors through the channel were admitted to the channel surgery group according to the wishes of the patients;otherwise,patients who underwent traditional laminectomy were included in the control group.From December 2017 to March 2019,a total of 15 patients(experimental group)were treated with minimally invasive surgery.A total of 15 patients with tumors similar in size and location to those in the experimental group were selected from the control group who were hospitalized during the same period for traditional laminectomy.Relevant clinical data of the two groups of patients were collected and analyzed,including preoperative lesion imaging characteristics,intraoperative blood loss,operation time,postoperative hospital stay,postoperative complications,symptom improvement,etc.Results the operating time of the experimental group and the control group was(157±27)min and(158±29)min,respectively(P=0.897).Intraoperative blood loss was(66±27)ml and(110±43)ml,respectively(P=0.020).The mean hospital stay was(7.60±1.29)days and(11.67±1.23)days,respectively(P=0.000).Postoperative JOA scores were 26.73±2.84 and 26.60±2.41,respectively(P=0.891).Postoperative VAS scores were 0.40±1.12 and 0.27±0.71,respectively(P=0.699).The mean blood loss and hospital stay in the experimental group were significantly lower than those in the control group,the difference in operation time between the two groups was not significant,and there was no difference in neurological function results.Conclusion In certain types of lumbar schwannoma tumors(non-giant tumors),minimally invasive resection through channels has the advantages of less surgical trauma,less bleeding,faster recovery and definite curative effect,which is a safe and effective surgical treatment.