CAJ | 학술논문

目的：探讨特殊临床表现的椎管内外生长的巨大哑铃形神经鞘瘤诊断与治疗方法。方法回顾研究暨南大学第二临床医学院2011年3月至2013年7月，以非脊柱疾病首诊入院的7例具有特殊临床表现的神经鞘瘤患者的诊疗过程及治疗方法与疾病转归。结果7例患者中，分别首诊于泌尿外科2例、肝胆外科1例、妇科2例、疼痛科1例、理疗科1例，经会诊或进一步检查后纠正诊断。7例患者中，5例伴有不同程度的椎管内神经受压症状，2例无明显椎管内神经受压症状，影像学检查提示神经源性肿瘤可能，后行瘤体切除术，术后病理检查为神经鞘瘤。术后平均随访1．3年，患者症状消失，未出现复发和新发症状。结论部分椎管内外生长的哑铃型神经鞘瘤有其特殊的临床表现，以腹部肿物压迫为初始症状，而椎管内神经受压症状出现较迟，临床医师应考虑到此病的可能性并进行进一步的检查，以便及早正确诊断。椎管内外联合包膜外切除术是治疗神经鞘瘤的有效方法。
목적：탐토특수림상표현적추관내외생장적거대아령형신경초류진단여치료방법。방법회고연구기남대학제이림상의학원2011년3월지2013년7월，이비척주질병수진입원적7례구유특수림상표현적신경초류환자적진료과정급치료방법여질병전귀。결과7례환자중，분별수진우비뇨외과2례、간담외과1례、부과2례、동통과1례、리료과1례，경회진혹진일보검사후규정진단。7례환자중，5례반유불동정도적추관내신경수압증상，2례무명현추관내신경수압증상，영상학검사제시신경원성종류가능，후행류체절제술，술후병리검사위신경초류。술후평균수방1．3년，환자증상소실，미출현복발화신발증상。결론부분추관내외생장적아령형신경초류유기특수적림상표현，이복부종물압박위초시증상，이추관내신경수압증상출현교지，림상의사응고필도차병적가능성병진행진일보적검사，이편급조정학진단。추관내외연합포막외절제술시치료신경초류적유효방법。
Objective To investigate the specific clinical manifestations,surgery treatment of internal and external growth of thoracolumbar intraspinal schwannomas and provide evidences for early diagnosis and treatment.Methods From March 2011 to July 2013,medical records of seven patients with spinal schwannoma were retrospectively reviewed,which were first diagnosed with non-spinal diseases. Results Among seven patients,two patients admitted to urology for the first time,one patient in department of hepatobiliary surgery,two cases in department of gynecology,one patient in department of pain,one case in department of physiotherapy.Patients got the right diagnosis after proper consultation and further examination.Among seven patients,five patients with different degree of spinal canal nerve compression symptoms including leg pain,numbness,weakness while two cases with no obvious symptoms.It may be neurogenic tumors by CT and MRI examination.Schwannoma were confirmed by postoperative pathological examination.In the following 1 .3 years,basic symptoms disappeared,it didn′t appear recurnence and new symptoms.Conclusions Parts of the internal and external growth of thoracolumbar intraspinal schwannomas have their specific clinical manifestations:abdominal mass oppression for initial symptoms,while spinal nerve compression symptoms appear later.Thinking of the possibility of the disease and relevant examination are the keys to the appropriate diagnosis and treatment.Combined extracapsular resection inside and outside the spinal canal is an effective way for internal and external growth of thoracolumbar intraspinal schwannomas.