CAJ | 학술논문

目的介绍骶尾部脊髓脂肪瘤的病理解剖及相应的手术技巧.方法 2005年9月至2012年1月,上海儿童医学中心手术治疗骶尾部脊髓脂肪瘤119例,年龄1个月至18岁,神经系统症状有大小便失禁和(或)双下肢功能障碍.手术方法包括:切除皮下和椎管内脊髓外的脂肪瘤,脊髓内的脂肪瘤大部分切除,将脊髓从两侧硬脊膜上剪开,圆锥从硬脊膜囊末端剪开并分离下来,松解脊髓栓系.结果骶尾部脊髓脂肪瘤主要病理解剖与腰骶部脊髓脂肪瘤相似,不同之处在于圆锥生长在末端硬膜囊上,圆锥发出的脊神经从圆锥腹侧斜向下方发出,脂肪瘤仅生长到脊髓内,并未生长到脊髓下方的脊神经内.108例得到随访,随访时间0.5～7.0年.术前有症状的患儿,术后多数有不同程度改善,1例症状加重,6例术后症状一过性加重；10例无症状者术后9例仍然无症状,1例症状一过性加重.结论只有充分认识骶尾部脊髓脂肪瘤病理解剖,才能最大限度地切除脂肪瘤,彻底解除脊髓栓系,同时又能避免神经损伤,重建脊髓的正常解剖结构,最大限度恢复神经功能.
목적 개소저미부척수지방류적병리해부급상응적수술기교.방법 2005년9월지2012년1월,상해인동의학중심수술치료저미부척수지방류119례,년령1개월지18세,신경계통증상유대소편실금화(혹)쌍하지공능장애.수술방법포괄:절제피하화추관내척수외적지방류,척수내적지방류대부분절제,장척수종량측경척막상전개,원추종경척막낭말단전개병분리하래,송해척수전계.결과 저미부척수지방류주요병리해부여요저부척수지방류상사,불동지처재우원추생장재말단경막낭상,원추발출적척신경종원추복측사향하방발출,지방류부생장도척수내,병미생장도척수하방적척신경내.108례득도수방,수방시간0.5～7.0년.술전유증상적환인,술후다수유불동정도개선,1례증상가중,6례술후증상일과성가중；10례무증상자술후9례잉연무증상,1례증상일과성가중.결론 지유충분인식저미부척수지방류병리해부,재능최대한도지절제지방류,철저해제척수전계,동시우능피면신경손상,중건척수적정상해부결구,최대한도회복신경공능.
Objective To introduce the pathological anatomies and surgical techniques of sacrococcygeal spinal cord lipomas.Methods Data was collected on 119 patients with sacrococcygeal spinal cord lipomas at Shanghai Children's Medical Center from September 2005 to January 2012,ages 1 month to 18 years,whose neurological symptoms included incontinence of urine and stool and/or malfunction of the lower extremities.The surgical procedures consisted of the excision of subcutaneous and intradural extramedullary lipoma,partial excision of the intramedullary lipoma,detachment of the spinal cord from the dural membrane,freeing the conus medullaris from the end of the dura sac,and relief of the tethered spinal cord.Results The main pathological changes of sacrococcygeal spinal cord lipomas were similar to those of the lumbosacral ones.The differences included that the conus medullaris growed with the end of dura sac,the spinal nerves of the conus medullaris originated from its ventral part and ran obliquely and inferiorly,the lipoma is located within the conus medullaris and beyond the spinal nerves below the conus medullaris.108cases were followed up for 0.5 to 7.0 years.Improvement after surgery varied amongst the symptomatic patients.The symptoms in 1 case worsened after surgery,transient deterioration of symptoms after surgery were seen in 6 cases,9 out of 10 asymptomatic patients remained asymptomatic while the rest showed transient deterioration of symptoms.Conclusions We could optimally excise the lipoma,untether the spinal cord and avoid damage to the spinal nerves,reconstruct the normal anatomy of the spinal cord,and rehabilitate neurological functions with the thorough understanding of the pathology of the sacrococcygeal spinal cord lipomas.