椎管内肿瘤163例临床分析

Clinical analysis of 163 cases with intraspinal tumors.

目的总结治疗椎管内肿瘤的经验。方法回顾性分析 163例经手术治疗、有明确病理诊断的椎管内肿瘤的病理类型与部位、临床症状和体征、影像学检查及手术治疗的方法和疗效。结果本组椎管内肿瘤中神经鞘膜瘤 5 8例 (3 5 .5 8% ) ,脊膜瘤 2 8例 (17.18% ) ,星形细胞瘤 11例 (6.75 % )、表皮样囊肿 10例 (6.13 % ) ,室管膜瘤和血管瘤各 8例 (4.91% ) ,脂肪瘤和畸胎瘤各 7例 (4.2 9% ) ,皮样囊肿 6例 (3 .68% ) ,蛛网膜囊肿 14例 (8.5 9% ) ,另有少见的肠源性囊肿、节细胞神经瘤和转移瘤。本组病例硬膜外肿瘤占 14.72 % ,髓外硬膜下肿瘤占 63 .19% ,髓内肿瘤占 2 2 .0 9%。肿瘤位于颈段占 3 1.90 % ,胸段占 41.10 % ,腰段占 19.63 % ,骶段占 7.3 6%。肿瘤全切除率 71.78% ,其中髓外肿瘤全切除率达74.80 % ,髓内肿瘤全切除率 61.11%。术后出院时 82 .82 %的病例症状有不同程度的改善 ,其中疼痛得到缓解的最多。有 11.0 4%的病例症状较术前无变化 ,另有 6.13 %的病例术后症状加重。结论椎管内肿瘤 3 / 4为良性 ,故手术全切除后预后良好 。

Objective To summarize the eperiences of treating intraspinal tumors.Methods The pathological types,location,clinical symptoms and signs,imaging examination and the methods and outcome of surgical treatment for the intraspinal tumors in 163 cases were retrospectively analyzed.Results The intrspinal tumors in those patients included neurinoma in 58 cases (35.58%) ,meningiomas in 28 cases(17.18%),astrocytoma in 11 cases(6.75%),epidermoid cyst in 10 cases(3.68%),ependymoma and hemangioma ,each in 8 cases(4.91%),lipoma and teratoma,each in 7 cases(4.29%),dermoid cyst in 6 cases (3.68%) and arachnoid cyst in 14 cases(8.59%),in addition,enterogenous cyst,ganglioneuroma and metastasis tumor were occasionally seen.In other side,epidural tumors,extramedullary subdural tumors and intramedullary tumors accounted for 14.72% ,63.19% and 22.09%,respectively.According to the locations,31.90% tumors located at cervical region,41.10% at thoracic region,19.63% at lumbar region and 7.36% at sacral segments.The total removal rates of tumors were 71.78%,among which,the total removal rates of extramedullary tumors and intramedullary tumors were 74.80% and 61.11%,respectively.On discharge after surgery,82.82% cases were improved to the different degree,in most of whom the pain was relieved. 11.04% cases were not changed compared with that before surgery,and 6.13% cases were worsened after surgery.Conclusion The surgical outcome is better because most of the intraspinal tumors are benign.MRI and microsurgical techniques contribute to the improvement of the total removal rates for the intraspinal tumors.