椎管内圆锥马尾区畸胎瘤的治疗
|
摘要
目的总结椎管内圆锥马尾区畸胎瘤的临床特点和治疗经验。方法回顾性分析1997年8月至2017年7月手术治疗的51例椎管内圆锥马尾区畸胎瘤的临床资料。结果肿瘤的囊性部分全切除46例,次全切除加囊壁电灼5例;肿瘤实性部分全切除5例,次全切除20例,大部切除26例。51例术后病理检查均为成熟性囊性畸胎瘤。术后发生脑脊液漏3例、泌尿系感染5例,均治愈。32例疼痛中,24例术后疼痛缓解或消失,8例无变化。12例运动障碍中,7例术后肌力提高1~3级,4例无变化,1例肌力下降。7例括约肌功能障碍中,4例改善,3例无变化。51例术后随访6个月~19年,平均7.8年,随访超过5年27例。按Mc Cormick分级标准,脊髓功能好转39例,不变11例,恶化1例。随访期间,未见肿瘤复发。结论椎管内畸胎瘤多分布于脊髓圆锥马尾区,以慢性脊髓及神经压迫为表现。手术应在显微镜下,尽量全切肿瘤的囊性部分,如有囊壁残留应电灼防止复发,对肿瘤的实性部分应在避免脊髓损伤情况下,尽量切除减压,手术疗效满意。
Objective To summarize the clinical features of teratomas in the regions of spinal conus and cauda equina and experience in treating them.MethodThe clinical data of 51 patients with intra-spinal teratomas in the regions of spinal conus and cauda equina, who were treated by surgery from August, 1997 to July, 2017, were analyzed retrospectively.Results Of 51 patients with teratomas in the regions of spinal conus and cauda equina, 46 received gross total resection of cystic component and 5 subtotal resection.The histopathological examination showed that the mature cystic teratomas were proved in all the patients, who were followed-up from 6 months to 19 years(mean, 7.8 years). The spinal neurological function evaluated by Mc Cormick grading scale was improved in 27 patients, unchanged in 23 and deteriorated in 1 during the following-up. The teratomas did not recur in all the patients.Conclusions The intra-spinal teratomas are mostly in the conus of spinal cord. Chronic pain and neurological fect are the main clinical manifestations. The key to the surgical treatment is total resection of the cystic component under the microscope as possible. The outcomes of surgical treatment are satisfactory in the patients with intraspinal teratomas in the regions of spinal conus and cauda equina.
Objective To summarize the clinical features of teratomas in the regions of spinal conus and cauda equina and experience in treating them.MethodThe clinical data of 51 patients with intra-spinal teratomas in the regions of spinal conus and cauda equina, who were treated by surgery from August, 1997 to July, 2017, were analyzed retrospectively.Results Of 51 patients with teratomas in the regions of spinal conus and cauda equina, 46 received gross total resection of cystic component and 5 subtotal resection.The histopathological examination showed that the mature cystic teratomas were proved in all the patients, who were followed-up from 6 months to 19 years(mean, 7.8 years). The spinal neurological function evaluated by Mc Cormick grading scale was improved in 27 patients, unchanged in 23 and deteriorated in 1 during the following-up. The teratomas did not recur in all the patients.Conclusions The intra-spinal teratomas are mostly in the conus of spinal cord. Chronic pain and neurological fect are the main clinical manifestations. The key to the surgical treatment is total resection of the cystic component under the microscope as possible. The outcomes of surgical treatment are satisfactory in the patients with intraspinal teratomas in the regions of spinal conus and cauda equina.
引文
[1]张忠,袁葛,李学真,等.椎管内先天性肿瘤的诊断与治疗:附135例分析[J].中国神经肿瘤杂志,2007,5(1):34-37.
[2]谢京城,王振宇,马长城,等.660例椎管肿瘤的手术治疗[J].中国微创外科杂志,2009,9(10):940-945.
[3]李德志,孔德生,郝淑煜,等.2 447例椎管内肿瘤的流行病学特点[J].中华神经外科杂志,2014,30(7):653-657.
[4]谢京城,王振宇,刘彬,等.椎管内畸胎瘤的诊断和治疗[J].中国脊柱脊髓杂志,2009,19(2):90-93.
[5]Hukuda S,Mochizuki T,Ogata M,et al.cervical spondylotic myelopathy:a comparison of the results of anterior and posterior procedures[J].J Bone Joint Surg(Br),1985,67(4):609-615.
[6]Mc Cormick PC,Torres R,Kalmon D,et al.Intramedullary ependymoma of the spinal cord[J].J Neurosurg,1990,72(4)523-532.
[7]Poeze M,Herpers M,Tjandra B,et al.Intramedullary spinal teratoma presenting with urinary retention:case report and review of the literature[J].Neurosurgery,1999,45(2):379-385.
[8]尚京伟,戴建平,高培毅.脊髓畸胎瘤的影像诊断[J].实用放射学杂志,2003,19(3):657-659.
[9]赵东升,王正君,孙刚锋,等.椎管内畸胎瘤的诊断与治疗[J].中国临床神经外科杂志,2015,20(11):661-664.
[10]高俊,李智敏,王天宇,等.成人椎管内先天性肿瘤的手术治疗[J].中国临床神经外科杂志,2016,21(11):670-672.
[11]谢京城,Hurlbert RJ.改良椎板成形术在颈椎管内肿瘤切除术中的应用[J].中华神经外科杂志,2007,23(11):864-867.
[2]谢京城,王振宇,马长城,等.660例椎管肿瘤的手术治疗[J].中国微创外科杂志,2009,9(10):940-945.
[3]李德志,孔德生,郝淑煜,等.2 447例椎管内肿瘤的流行病学特点[J].中华神经外科杂志,2014,30(7):653-657.
[4]谢京城,王振宇,刘彬,等.椎管内畸胎瘤的诊断和治疗[J].中国脊柱脊髓杂志,2009,19(2):90-93.
[5]Hukuda S,Mochizuki T,Ogata M,et al.cervical spondylotic myelopathy:a comparison of the results of anterior and posterior procedures[J].J Bone Joint Surg(Br),1985,67(4):609-615.
[6]Mc Cormick PC,Torres R,Kalmon D,et al.Intramedullary ependymoma of the spinal cord[J].J Neurosurg,1990,72(4)523-532.
[7]Poeze M,Herpers M,Tjandra B,et al.Intramedullary spinal teratoma presenting with urinary retention:case report and review of the literature[J].Neurosurgery,1999,45(2):379-385.
[8]尚京伟,戴建平,高培毅.脊髓畸胎瘤的影像诊断[J].实用放射学杂志,2003,19(3):657-659.
[9]赵东升,王正君,孙刚锋,等.椎管内畸胎瘤的诊断与治疗[J].中国临床神经外科杂志,2015,20(11):661-664.
[10]高俊,李智敏,王天宇,等.成人椎管内先天性肿瘤的手术治疗[J].中国临床神经外科杂志,2016,21(11):670-672.
[11]谢京城,Hurlbert RJ.改良椎板成形术在颈椎管内肿瘤切除术中的应用[J].中华神经外科杂志,2007,23(11):864-867.