中国肿瘤临床与康复

目的探讨椎管内肿瘤的显微外科治疗术式与方法选择,脊柱脊髓与神经功能的保护和重建,评价半椎板切除入路的优缺点。方法回顾性分析2004年1月至2007年7月经半椎板或全椎板手术切除椎管内肿瘤及对沟通性肿瘤部分采用附加切口手术共56例。椎管内外沟通性肿瘤8例;1例颈部与1例胸部沟通性肿瘤未切除椎板,余下均行椎板切除。结果手术后病理为:神经鞘瘤28例,脊膜瘤18例,神经节细胞瘤4例,星形细胞瘤4例,室管膜瘤2例;除星形细胞瘤2例外未能全切,其余均全切。半椎板切除入路者无手术并发症和脊柱畸形,术后下床早。结论经半椎板切除入路较全椎板入路显微外科手术切除椎管内肿瘤,能够尽可能减少对椎体损伤,保留脊柱后柱结构,组织的完整性;增强脊柱稳定性及减少脊柱功能损伤;患者术后效果好,卧床时间短;对椎管内外沟通性肿瘤根据具体情况选择合适的入路方法,同样可取得较好疗效。

Objective To explore the different approaches and methods for treating intraspinal tumors with microsurgical technique,to protect and rebuild the spine,spinal cord and its neural functions,and to evaluate the advantages and disadvantages of unilateral hemilaminectomy for the removal of intraspinal tumors.Methods A retrospective analysis was made on 56 cases of intraspinal tumors undergoing hemilamilectomy or total laminectomy and perforative tumors undergoing additional incision during Jan,2004 to July 2007.There were 8 cases of intra-extra-spinal communicating tumors.One case of neck perforative tumor and 1 case of thoracic perforative tumor were operated without removing lamina of vertebra,while the others were operated with laminectomy.Results Pathological reports after operation: 28 cases of neurinoma,18 cases of spinal meningioma,4 cases of ganglioma,4 cases of astrocytoma,and 2 cases of ependymoma.All the tumors were operated with total excision,except 2 cases of astrocytoma.The patients undergoing hemilaminectomy had no complication and spine deformity,and recovered faster than those with total laminectomy.Conclusions Unilateral hemilaminectomy for the removal of intraspinal tumors is a mini-invasive procedure,which is beneficial to the stabitity of the spine,with the advantages of shortlength of hospital stay,slight reactions,and ideal long-term effects,but sometimes the exposure of operative field is limited.