微通道治疗症状性骶管囊肿的临床效果

Clinical effect of minimally invasive treatment of symptomatic sacral cysts through microchannel keyhole approaches

目的探讨应用微通道治疗症状性骶管囊肿的可行性和临床效果。方法回顾性分析2017年2月至2019年12月北京大学第三医院神经外科收治的45例症状性单发骶管囊肿的临床资料。45例患者均采用微通道牵开进行个体化骶管后壁切除(宽度≤1.5 cm),然后在显微镜下切除囊肿。采用疼痛视觉模拟评分(VAS)评估患者的疼痛情况,以日本骨科学会(JOA)评分评估患者的神经功能情况。行影像学随访评估囊肿有无复发。结果45例患者的手术时间为(97.0±12.6)min(75~120 min);术后住院时间为(6±1)d(5~9 d)。45例患者中,41例骶管囊肿全切除,4例次全切除(远端囊壁旷置)。所有患者的术后病理学结果均提示为单纯囊肿。除4例术后出现骶尾部麻木感外,其余41例患者未出现神经功能障碍加重。45例患者术后随访3~36个月(中位时间为15个月),4例出现骶尾部麻木感者均恢复正常,未见囊肿复发。末次随访VAS为0~3分(中位数为0分),与术前的1~10分(中位数为3分)相比,差异有统计学意义(Z=-5.866,P<0.001);末次随访时的JOA评分[(28.7±1.1)分(22~29分)]较术前[(21.6±3.9)分(14~28分)]升高,差异有统计学意义(t=-13.726,P<0.001)。结论应用微通道治疗症状性骶管囊肿可有效缓解其临床症状,且并发症少,复发率低。

Objective To explore the feasibility and effect of microchannel keyhole technique in minimally invasive resection of symptomatic sacral cysts.Methods The clinical data of 45 patients with symptomatic solitary sacral cyst who were admitted to the Department of Neurosurgery,Peking University Third Hospital from February 2017 to December 2019 were retrospectively analyzed.All 45 patients underwent individualized laminectomy of posterior wall of sacral canal and then microsurgical resection of cyst through microchannel(width≤1.5 cm).The patients′pain conditions were evaluated based on the visual analogue scale(VAS)and their neurological functions were assessed using the Japanese Orthopedics Association(JOA)scale.The recurrence of cyst was evaluated by imaging follow-up.Results The operation duration was 97.0±12.6 min(75-120 min).The length of hospital stay post operation was 6±1 days and ranged from 5 to 9 days.Of 45 patients,total resection of sacral cysts was achieved in 41 cases and subtotal resection with distal cyst wall remaining in 4 cases.Pathological results showed that all of sacral cysts were simple cysts.Except for 4 patients with numbness in the sacrococcygeal region after operation,the remaining 41 patients did not experience aggravation of neurological dysfunction.Forty-five patients were followed up for 3 to 36 months after surgery(median:15 months).All 4 patients with sacrococcygeal numbness returned to normal,and no cyst recurrence was seen.The last follow-up VAS was 0 to 3 points(median:0 points),and compared with 1 to 10 points before surgery(median:3 points),the difference was statistically significant(Z=-5.866,P<0.001).The JOA score at the last follow-up(28.7±1.1 points;range:22-29 points)increased compared with that prior to operation(21.6±3.9 points;range:14-28 points)and the difference was statistically significant(t=-13.726,P<0.001).Conclusion The application of microchannel keyhole approach in the minimally invasive treatment of symptomatic sacral cysts can effectively relieve the clinical symptoms with few complications and low recurrence rate.