CAJ | 학술논문

目的探讨症状性骶管囊肿的显微手术治疗方式.方法 18例症状性骶管囊肿按分类采用不同手术方式.按照有无交通孔分为神经周围囊肿、神经根袖扩张两种,后者又分为单纯交通型和神经根袖型.神经周围囊肿在保护神经根前提下囊肿壁大部分切除或全切除;单纯交通型交通孔根部荷包缝合收紧;神经根袖型交通孔处脂肪垫保护荷包缝合,适度收紧,残留神经袖套塑形重建.残腔均用带蒂脂肪填塞.结果 18例术后随访6～36个月(平均18个月),囊肿未见复发.术后16例症状改善,2例仍存在疼痛及麻木不适感,不影响生活及工作.结论症状性骶管囊肿应根据囊肿不同类型行显微手术治疗.在保护神经的前提下切除囊肿,交通孔处荷包缝合,神经袖套塑形重建,带蒂脂肪填塞残腔.此手术方式安全、效果好,复发率低.
목적 탐토증상성저관낭종적현미수술치료방식.방법 18례증상성저관낭종안분류채용불동수술방식.안조유무교통공분위신경주위낭종、신경근수확장량충,후자우분위단순교통형화신경근수형.신경주위낭종재보호신경근전제하낭종벽대부분절제혹전절제;단순교통형교통공근부하포봉합수긴;신경근수형교통공처지방점보호하포봉합,괄도수긴,잔류신경수투소형중건.잔강균용대체지방전새.결과 18례술후수방6～36개월(평균18개월),낭종미견복발.술후16례증상개선,2례잉존재동통급마목불괄감,불영향생활급공작.결론 증상성저관낭종응근거낭종불동류형행현미수술치료.재보호신경적전제하절제낭종,교통공처하포봉합,신경수투소형중건,대체지방전새잔강.차수술방식안전、효과호,복발솔저.
Objective To explore the clinical features and microsurgical treatment of symptomatic sacral canal cyst.Methods 18 cases with symptomatic sacral canal cyst were operated through different surgical modes according to the classifications.According to the relationship with communicating foramen,these cysts were divided into two types:perineural cyst and nerve root sleeve expansion.While the latter was divided into two subtypes:simple communicating and the sleeve of the nerve root.For perineural cyst,we performed subtotal or total resection of the cyst wall under the protection of nerve roots.For the simple communicating cyst,we performed purse-string suture in the neck of cyst.For the cyst with sleeve of the nerve root,we performed partial cyst excision,plication of the cyst wall,purse-string suture in the neck of cyst and remodel the sleeve of the nerve root.The residual cavity area was tamped by a fascial fat with pedicle.Results 18 patients were followed-up for 6-36 months (an average of 18 months) and there was no cyst recurrence.16 out of 18 patients experienced complete or substantial resolution of the preoperative local and radicular pain.Two patients still complained of mildly pain and numbness but could be tolerated without influence on their daily life.Conclusions Microsurgical treatment should be selected for patients with symptomatic sacral canal cysts according to the different types of cysts,including total or partial cyst excision combined with direct dural closure,purse-string suture in the neck of cyst,remodeling the sleeve of the nerve root and pedicled fat filling the cavity under the protection of nerve roots.Effective and safe treatment of symptomatic sacral canal cyst with low recurrence could be achieved.