儿童骶管神经束膜囊肿的诊治探讨

Diagnosis and treatment of sacral perineural cyst in children

目的探讨儿童症状性骶管神经束膜囊肿的临床特点及手术疗效。方法回顾性分析2014年4月—2022年7月在苏州大学附属儿童医院通过显微镜下神经束膜重建的手术方式治疗的13例儿童症状性骶管神经束膜囊肿的临床表现、手术经过及手术后随访情况。结果儿童骶管神经束膜囊肿中以尿道和肠道括约肌障碍为主要就诊症状。13例患儿均行囊肿大部切除及神经根束膜重建显微手术治疗。术后未发生伤口感染,无新发并发症。术后随访8个月~9年,平均(4.2±2.8)年。12例患儿症状改善或消失(12/13),1例患儿症状未改善(1/13)。术后6个月复查腰骶椎核磁共振成像(MRI)显示12例囊肿无复发,1例合并马凡氏综合征的患儿囊肿复发并有残腔积液。结论儿童骶管神经束膜囊肿以尿道和肠道括约肌障碍为主要表现,对儿童不明原因的排尿排便异常需考虑骶管囊肿可能;显微镜下神经根束膜重建是治疗儿童症状性骶管神经束膜囊肿的有效而安全的方法。症状性骶管神经束膜囊肿合并马凡氏综合征的患儿手术应慎重。

Objective To explore the clinical characteristics and surgical efficacy of symptomatic sacral perineural cyst in children.Methods The clinical manifestations,surgical procedures and postoperative follow-up of 13 children with symptomatic sacral perineural cyst who were treated with neurotracheal reconstruction under microscope in Children's Hospital Affiliated to Soochow University from April 2014 to July 2022 were analyzed retrospectively.Results The main symptoms in children with sacral perineural cyst were urethra and intestinal sphincter disorders.In this group,13 children underwent microsurgery for cyst resection and nerve root membrane reconstruction.There was no wound infection and no new complications.Postoperative follow-up was 8 months to 9 years,with an average of(4.2±2.8)years.Symptoms improved or disappeared in 12 cases(12/13),and 1 reported no improvement in symptoms(1/13).6 months after surgery,lumbosacral spine magnetic resonance imaging(MRI)showed that 12 cases of cysts were not repeated,and 1 with Marfan's syndrome had cyst recurrence and residual effusion.Conclusions Children's symptomatic sacral perineural cyst are mainly manifested with urethra and intestinal sphincter disorders.The possibility of sacral perineural cyst should be considered for unexplained abnormal urination and defecation in children.Microscopic reconstruction of nerve root membrane is an effective and safe method for treating symptomatic sacral cyst in children.Surgery should be cautious in children with symptomatic sacral cyst and Marfan's syndrome.