颈部神经鞘瘤27例临床分析

Clinical analysis of cervical schwannoma in 27 cases

目的探讨颈部神经鞘瘤的临床特征、影像学表现、治疗手段、预后及其影响因素。方法回顾并收集2013年1月~2021年12月在南京医科大学附属泰州人民医院诊治,经病理证实的27例颈部神经鞘瘤患者的临床病历资料。27例中,有神经症状组4例,瘤体平均最大直径(6.25±1.23)cm;无神经症状组23例,瘤体平均最大直径(3.25±0.85)cm。结果两组比较有统计学差异(P<0.01)。随访6~96个月,中位随访37个月。术后无1例肿瘤复发,术后1例迷走神经鞘瘤患者出现声带麻痹,3月后恢复;1例颈交感神经鞘瘤患者术前出现Horner综合征,术后2月消失;另1例术后出现Horner综合征,也于术后2月消失。2例术前手臂麻木术后1例出现疼痛,另1例出现上举无力,随访3个月后症状缓解。结论瘤体越大产生神经症状可能性越大;手术切除是治疗神经鞘瘤的主要方法,术前应根据病史、位置和影像学结果,尽可能明确诊断,术中保护神经,减少术后并发症。

Objective To investigate the clinical features,imaging findings,treatments,prognosis and influencing factors of cervical schwannoma.Methods The clinical records of 27 patients with cervical schwannoma confirmed by pathology were reviewed and collected from January 2013 to December 2021 in Taizhou People's Hospital Affiliated to Nanjing Medical University.Of the 27 cases,4 had neurological symptoms,and the mean maximum tumor diameter was(6.25±1.23)cm.The mean maximum tumor diameter was(3.25±0.85)cm in 23 patients without neurological symptoms.Results There was a statistical difference between the two groups(P<0.01).Follow-up ranged from 6 to 96 months,with a median follow-up of 37 months.There was no recurrence of tumor after operation,and 1 case of vagus schwannoma had vocal cord paralysis after operation,which recovered 3 months later.One case of cervical sympathetic schwannoma developed Horner syndrome before surgery,which disappeared 2 months after surgery.The other case developed Horner syndrome after surgery,which also disappeared 2 months after surgery.In 2 cases of arm numbness before surgery,1 case had pain and the other case had weakness after operation.The symptoms were relieved after 3 months of follow-up.Conclusion The larger the tumor,the more likely it is to produce neurological symptoms.Surgical resection is the main method for the treatment of schwannoma.Preoperative diagnosis should be made as clear as possible according to the history,location and imaging results,so as to protect nerves during the operation and reduce postoperative complications.