中国实用神经疾病杂志
中國實用神經疾病雜誌
중국실용신경질병잡지
Chinese Journal of Practical Nervous Diseases
2015年
23期
8-9
,共2页
椎管内髓外硬膜下肿瘤%半椎板切除术%显微外科手术%脊柱稳定性
椎管內髓外硬膜下腫瘤%半椎闆切除術%顯微外科手術%脊柱穩定性
추관내수외경막하종류%반추판절제술%현미외과수술%척주은정성
Intraspinal extramedullary tumors%Half laminectomy%Microsurgery%Spinal stability
目的：探讨经半椎板切除入路显微操作摘除椎管内髓外硬膜下肿瘤（IDEM ）的手术方法，进一步阐明其临床效果。方法以2009‐01—2012‐02我院收治的IDEM 患者20例为研究对象。16例行半椎板入路切除肿瘤，4例术中改为全椎板入路切除肿瘤。通过术前和术后Frankel分级评价半椎板入路的临床效果。结果术中平均出血量300 mL ，平均手术时间140 min。术后病理证实，2例神经纤维瘤，5例脊膜瘤，13例神经鞘瘤。切除的瘤体最大3.5 cm ×1.5 cm ×1.5 cm ，最小1.0 cm ×1.0 cm ×1.0 cm。20例患者中，术前Frankel分级B级4例，术后提高为C级；术前C级6例，术后提高为D级；术前D级9例，术后提高为E级。所有患者均随访6～28个月，平均19个月。20例脊柱稳定性良好且均未见复发。行半椎板入路及全椎板入路的平均出血量分别为270 mL和470 mL。结论半椎板切除术治疗IDEM具有损伤较小、出血较少等优点，且可以最大限度维持脊柱的稳定性。
目的：探討經半椎闆切除入路顯微操作摘除椎管內髓外硬膜下腫瘤（IDEM ）的手術方法，進一步闡明其臨床效果。方法以2009‐01—2012‐02我院收治的IDEM 患者20例為研究對象。16例行半椎闆入路切除腫瘤，4例術中改為全椎闆入路切除腫瘤。通過術前和術後Frankel分級評價半椎闆入路的臨床效果。結果術中平均齣血量300 mL ，平均手術時間140 min。術後病理證實，2例神經纖維瘤，5例脊膜瘤，13例神經鞘瘤。切除的瘤體最大3.5 cm ×1.5 cm ×1.5 cm ，最小1.0 cm ×1.0 cm ×1.0 cm。20例患者中，術前Frankel分級B級4例，術後提高為C級；術前C級6例，術後提高為D級；術前D級9例，術後提高為E級。所有患者均隨訪6～28箇月，平均19箇月。20例脊柱穩定性良好且均未見複髮。行半椎闆入路及全椎闆入路的平均齣血量分彆為270 mL和470 mL。結論半椎闆切除術治療IDEM具有損傷較小、齣血較少等優點，且可以最大限度維持脊柱的穩定性。
목적：탐토경반추판절제입로현미조작적제추관내수외경막하종류（IDEM ）적수술방법，진일보천명기림상효과。방법이2009‐01—2012‐02아원수치적IDEM 환자20례위연구대상。16례행반추판입로절제종류，4례술중개위전추판입로절제종류。통과술전화술후Frankel분급평개반추판입로적림상효과。결과술중평균출혈량300 mL ，평균수술시간140 min。술후병리증실，2례신경섬유류，5례척막류，13례신경초류。절제적류체최대3.5 cm ×1.5 cm ×1.5 cm ，최소1.0 cm ×1.0 cm ×1.0 cm。20례환자중，술전Frankel분급B급4례，술후제고위C급；술전C급6례，술후제고위D급；술전D급9례，술후제고위E급。소유환자균수방6～28개월，평균19개월。20례척주은정성량호차균미견복발。행반추판입로급전추판입로적평균출혈량분별위270 mL화470 mL。결론반추판절제술치료IDEM구유손상교소、출혈교소등우점，차가이최대한도유지척주적은정성。
Objective To investigate the method and effect of half laminectomy approach micromanipulator removal in‐traspinal extramedullary tumor.Methods Twenty cases of patients with IDEM from Jan. 2009 to Feb. 2012 were selected. Sixteen cases underwent tumor resection half laminectomy approach ,4 patients underwent laminectomy approach to remove the tumor. Clinical results were assessed by Frankel Grading.Results The mean intra‐operative blood loss was 300 mL ,mean op‐eration time was 140 min. Postoperative pathology confirmed that 2 cases of neurofibroma ,5 cases of meningioma ,and 13 ca‐ses of Schwannoma. Resection of the tumor was up to 3.5 cm × 1.5 cm × 1.5 cm ,the smallest was 1.0 cm × 1.0 cm × 1.0 cm. In the 20 patients ,preoperative 4 cases with Frankel grade B ,which postoperative increased to grade C ;preoperative 6 cases with grade C ,which postoperative increased to grade D ;preoperative 9 cases with grade D ,which postoperative increased to grade E. All patients were followed up 6~28 months ,with an average follow‐up of 19 months. 20 cases with good spinal sta‐bility showed no recurrence. The average amount of bleeding of half laminectomy approach and laminectomy approach was re‐spectively 270 mL and 470 mL.Conclusion Half laminectomy for IDEM with smaller damage ,less bleeding ,etc. and can maintain the stability of the spine.
