中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2015年
8期
803-806
,共4页
脊索瘤%骶尾部%显微外科手术%整块切除术
脊索瘤%骶尾部%顯微外科手術%整塊切除術
척색류%저미부%현미외과수술%정괴절제술
Chordoma%Sacrococcygeal region%Microsurgery%En bloc resection
目的 探讨神经外科显微技术与整体切除(En-bloc)理念相结合在中低位骶部脊索瘤切除术中的应用价值.方法 仅累及S3以下(包括S3)的脊索瘤称之为中低位骶部脊索瘤,自2007年10月至2012年12月手术治疗中低位骶部脊索瘤11例.术中以En-bloc整体切除理念为指导原则,在具体切除过程中应用神经外科显微技术进行截骨、神经解剖及肿瘤分离,观察手术效果及并发症.结果 在保持包膜完整的情况下肿瘤均全切,平均手术时间141 min,平均失血量420 ml.显微镜下神经辨识清楚,双侧S3以上神经前根保留完整9例,保留单侧S3神经前根2例,术后6个月大小便功能完全存在10例,部分存在1例.平均随访3.7年,有2例局部复发.结论 中低位骶部脊索瘤手术中,En-bloc与显微神经外科技术相结合,有利于肿瘤完整切除及保护神经功能,减少手术失血量,复发率低.
目的 探討神經外科顯微技術與整體切除(En-bloc)理唸相結閤在中低位骶部脊索瘤切除術中的應用價值.方法 僅纍及S3以下(包括S3)的脊索瘤稱之為中低位骶部脊索瘤,自2007年10月至2012年12月手術治療中低位骶部脊索瘤11例.術中以En-bloc整體切除理唸為指導原則,在具體切除過程中應用神經外科顯微技術進行截骨、神經解剖及腫瘤分離,觀察手術效果及併髮癥.結果 在保持包膜完整的情況下腫瘤均全切,平均手術時間141 min,平均失血量420 ml.顯微鏡下神經辨識清楚,雙側S3以上神經前根保留完整9例,保留單側S3神經前根2例,術後6箇月大小便功能完全存在10例,部分存在1例.平均隨訪3.7年,有2例跼部複髮.結論 中低位骶部脊索瘤手術中,En-bloc與顯微神經外科技術相結閤,有利于腫瘤完整切除及保護神經功能,減少手術失血量,複髮率低.
목적 탐토신경외과현미기술여정체절제(En-bloc)이념상결합재중저위저부척색류절제술중적응용개치.방법 부루급S3이하(포괄S3)적척색류칭지위중저위저부척색류,자2007년10월지2012년12월수술치료중저위저부척색류11례.술중이En-bloc정체절제이념위지도원칙,재구체절제과정중응용신경외과현미기술진행절골、신경해부급종류분리,관찰수술효과급병발증.결과 재보지포막완정적정황하종류균전절,평균수술시간141 min,평균실혈량420 ml.현미경하신경변식청초,쌍측S3이상신경전근보류완정9례,보류단측S3신경전근2례,술후6개월대소편공능완전존재10례,부분존재1례.평균수방3.7년,유2례국부복발.결론 중저위저부척색류수술중,En-bloc여현미신경외과기술상결합,유리우종류완정절제급보호신경공능,감소수술실혈량,복발솔저.
Objective To investigate the application value of microneurosurgery in combination with en-bloc idea in the resection of middle-lower sacral chordomas.Methods The chordomas only involving under S3 (including S3) are known as the middle-lower sacral chordomas.Eleven patients with middle-lower sacral chordoma were treated surgically from October 2007 to December 2012.The en-bloc resection concept was used as a guiding principle during the operation;osteotomy,nerve anatomy,and tumor separation were performed by using microneurosurgical technique in the specific removal process.The effect of operation and complications were observed.Results In the case of keeping the capsule intact,the sacral chordomas were totally removed.The mean time of operation was 141 min,and the mean blood loss was 420 ml.The nerves were clearly identified under the microscope.The anterior nerve roots above bilateral S3 were retained completely in 9 cases,and the anterior nerve roots of the unilateral S3 were retained completely in 2 cases.The bowel and bladder functions were preserved completely in 10 cases at 6 months after procedure,and partially preserved in one case.The patients were followed up for a mean of 3.7 years.Two patients had local recurrence.Conclusions In the middle-lower sacral chordoma surgery,en-bloc resection in combination with microneurosurgery technique is conducive to en-bloc resection of sacral chordomas and protection of neurological function,and reduction of introperative blood loss.The recurrence rate is low.
