54例脊髓髓内肿瘤的诊断与手术治疗

Diagnosis and Microsurgical Treatment of Intramedullary Spinal Cord Tumors in 54 Cases

目的 :探讨脊髓髓内肿瘤的诊断与手术治疗。方法 :回顾性分析 5 4例脊髓髓内肿瘤的临床特征、诊断标准及手术方法与手术疗效。所有病例均行MRI检查 ,三维上肿瘤均在髓内方可诊断为脊髓髓内肿瘤。结果 :髓内肿瘤最常见的首发症状是肢体感觉麻木、疼痛 ,早期括约肌紊乱不明显 ,病情加重出现肢体感觉和运动障碍 ;手术全切除 35例 ,大部切除 10例 ;病理报告前三位是星形细胞瘤 2 0例 ,室管膜瘤 13例 ,脂肪瘤 8例。术后运动及感觉障碍改善 4 0例 ,改善不明显 6例 ,加重 8例 ,手术死亡 4例 ;随访 4 6例 ,4例死亡 ,5例肿瘤复发。结论 :MRI对脊髓髓内肿瘤的诊断特异性高 ,髓内肿瘤应早期诊断 ,掌握时机 ,尽早力争全切 ,对恶性和未全切肿瘤行放疗 ,疗效显著 ,手术方法随肿瘤类型不同而异。

Objective:To discuss the diagnosis and microsurgical treatment of intramedullary spinal cord tumors. Methods:54 patients with intramedullary spinal cord tumors were analyzed retrospectively with regards to clinical manifestations,diagnosis critera,operation approaches and long-term results.All patients were examined by MRI. Tumors located intramedullarly under 3 D MRI were diagnosed as intramedullary spinal cord tumors. Results:Limbs pain and numbness were the most common initial symptoms of spinal cord tumors. Limbs motion and sensory disability are in progression. Autonomic dysfunction affecting bowel and bladder control were late symptoms. All tumors were tesected,totally in 35 cases and subtotally in 10.Pathology confirmed that 13 cases were of ependymoma,20 of astrocytoma and 8 of lipoma.The postoperative neurological functions were improved in 40 patients,remained unchanged in 6 and aggravated in 8. Four deaths occurred at surgery.46 patients were followed up,4 died,5 recurrent with tumor. Conclusion:MRI was specific in diagnosis of intramedullary spinal cord tumors. Most of them need operations as early as possible. Radiation therapy was necessary for the malignant or subtotally removed tumors of better outcomes.Various operative approaches were chosen for different kinds of intramedullary spinal cord tumors.