CAJ | 학술논문

目的：探讨经后路全椎板切除治疗椎管内神经鞘瘤的临床疗效。方法对2009年1月至2012年6月共42例椎管内神经鞘瘤患者行后路全椎板切除入路摘除椎管内神经鞘瘤。其中男18例，女24例；年龄36~72岁，平均53岁。病程2个月~3年，平均10.6个月。肿瘤发病节段：颈段3例，胸段25例，腰段12例，骶段2例。神经损害按Frankel分级：B级2例，C级8例，D级20例，E级12例。术后定期门诊随访，同时电话或门诊进行>12个月的末次随访。观察临床疗效，复查X线片及MRI，观测内固定的稳定情况及肿瘤有无复发。结果42例患者肿瘤术中完整切除，术后病理证实神经鞘瘤。手术时间1.5~3.5h，平均2.0h，术中出血量30~200ml。术后8例患者出现不同程度的脑脊液漏，予绝对卧床、局部加压、缝合处理后，脑脊液漏停止。2例胸段载瘤神经根切除后出现胸壁感觉麻木异常，给予甲钴胺及加巴喷汀处理口服处理后，症状2~4个月内逐渐消失。获随访患者39例，平均随访时间12~35个月，平均22个月。随访期内，39例患者MRI复查无肿瘤复发，内固定位置好，无松动断裂现象。术后神经功能恢复Frankel分级，D级9例，E级30例。结论经后路全椎板切除治疗椎管内神经鞘瘤能获得较好的临床疗效，MRI在肿瘤的诊治中起重要作用，脑脊液漏及载瘤神经根切除是防止复发和手术成功的关键。
목적：탐토경후로전추판절제치료추관내신경초류적림상료효。방법대2009년1월지2012년6월공42례추관내신경초류환자행후로전추판절제입로적제추관내신경초류。기중남18례，녀24례；년령36~72세，평균53세。병정2개월~3년，평균10.6개월。종류발병절단：경단3례，흉단25례，요단12례，저단2례。신경손해안Frankel분급：B급2례，C급8례，D급20례，E급12례。술후정기문진수방，동시전화혹문진진행>12개월적말차수방。관찰림상료효，복사X선편급MRI，관측내고정적은정정황급종류유무복발。결과42례환자종류술중완정절제，술후병리증실신경초류。수술시간1.5~3.5h，평균2.0h，술중출혈량30~200ml。술후8례환자출현불동정도적뇌척액루，여절대와상、국부가압、봉합처리후，뇌척액루정지。2례흉단재류신경근절제후출현흉벽감각마목이상，급여갑고알급가파분정처리구복처리후，증상2~4개월내축점소실。획수방환자39례，평균수방시간12~35개월，평균22개월。수방기내，39례환자MRI복사무종류복발，내고정위치호，무송동단렬현상。술후신경공능회복Frankel분급，D급9례，E급30례。결론경후로전추판절제치료추관내신경초류능획득교호적림상료효，MRI재종류적진치중기중요작용，뇌척액루급재류신경근절제시방지복발화수술성공적관건。
Objective To investigate the clinical efficacy and diagnosis&treatment experience of posterior laminectomy in patients with intraspinal neurilemmoma. Methods A total of 42 cases (18 males,24 females) with intraspinal neurilemmoma from Jan. 2009 to June 2012 was reviwed retrospectively. The age was 36-72 years (53 years on average),and the course of disease was 2 months to 3 years(10.6 months on average). Of all cases,3 cases had tumor in cervical segment,25 cases in thoracis segment,12 cases in lumbar segment,and 2 cases in sacral segment. According to Frankel’s grading,the nerve function grade of all cases before surgery is:B, 2 cases;C,8 cases;D,20 cases and E,12 cases. All patients underwent posterior laminectomy to resect intraspinal neurilemmoma. Patients were followed up by phone or clinic for more than 12 months. The clinical efficacy,the spinal internal fixation stability as well as tumor recurrence were observed by X-ray and MRI. Results All 42 patients’ tumors were completely resected and confirmed as neurilemmoma by pathological test,with operative time of 1.5-3.5h (2.0h on average) and blood loss of 30-200ml. The cerebrospinal fluid leakage was found in 8 cases,but stopped after absolute bed rest,local compression and suture treatment. 2 patients experienced numbness in chest after thoracis nerve roots supplying tumor were resected. The symptoms disappeared gradually in 2-4 months after Mecobalamin and Gabapentin was taken orally. 39 patients were available for follow-up. The follow-up period was 12-35 months (22 months on average). During the follow-up period,no tumor recurrence was observed by MRI,internal fixation location was stable,and no spondylolisthesis and instability was observed. According to Frankel’s grading,the nerve function grade of all cases after surgery is:D,9 cases and E,30 cases. Conclusion The clinical efficacy of posterior laminectomy in patients with intraspinal neurilemmoma was satisfactory. MRI plays an important role in tumor diagnosis and treatment. And the prevention and treatment of cerebrospinal fluid leakage and nerve root supplying tumor was essential for a successful surgery.