儿童皮毛窦的诊断及治疗效果分析
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摘要
目的探讨儿童皮毛窦的诊断方法和手术治疗效果。方法回顾性分析山东大学齐鲁儿童医院2015年1月至2018年6月收治的15例儿童皮毛窦患儿临床资料,所有患儿术前接受MRI检查,且行皮毛窦切除术。结果术前影像学检查发现15例均有皮肤窦道。5例合并皮样囊肿; 2例合并脂肪瘤; 1例合并脊髓纵裂; 1例合并中央管扩大。脊柱三维CT重建检查发现10例合并脊柱裂。术后病理结果均证实为皮毛窦。镜下可见毛发毛干,窦道及其周围组织,炎性肉芽增生组织。所有患儿均获得随访,随访时间6～12个月,术前症状消失或明显改善,窦道未见复发。结论儿童皮毛窦早期诊断及手术治疗有助于改善患儿预后及减少严重并发症的发生。
Objective To explore the diagnostic methods and surgical efficacies of dermal sinus tracts.Methods The clinical data of 15 hospitalized children with dermal sinus tracts from January 2015 to June 2018 were retrospectively analyzed. All children received preoperative magnetic resonance imaging( MRI) examination and underwent dermal sinus tract resection. Results All cases were confirmed by imaging examinations.The concurrent conditions included dermoid cyst( n = 5),lipoma( n = 2),diastematomyelia( n = 1) and ectattic central canal( n = 1). Three-dimensional computed tomography( CT) spinal reconstruction revealed complicated diastematomyelia( n = 10). Postoperative pathological examination confirmed the diagnosis of dermal sinus tracts. And microscopic examination revealed hair stem,sinus tract and adjoining tissues with inflammatory granulation. During a follow-up period of 6-12 months,the symptoms disappeared or improved significantly after operation. No recurrence of sinus tract was found. Conclusion Early diagnosis and surgical treatment of dermal sinus in children can improve the prognosis and reduce the occurrence of serious complications.
Objective To explore the diagnostic methods and surgical efficacies of dermal sinus tracts.Methods The clinical data of 15 hospitalized children with dermal sinus tracts from January 2015 to June 2018 were retrospectively analyzed. All children received preoperative magnetic resonance imaging( MRI) examination and underwent dermal sinus tract resection. Results All cases were confirmed by imaging examinations.The concurrent conditions included dermoid cyst( n = 5),lipoma( n = 2),diastematomyelia( n = 1) and ectattic central canal( n = 1). Three-dimensional computed tomography( CT) spinal reconstruction revealed complicated diastematomyelia( n = 10). Postoperative pathological examination confirmed the diagnosis of dermal sinus tracts. And microscopic examination revealed hair stem,sinus tract and adjoining tissues with inflammatory granulation. During a follow-up period of 6-12 months,the symptoms disappeared or improved significantly after operation. No recurrence of sinus tract was found. Conclusion Early diagnosis and surgical treatment of dermal sinus in children can improve the prognosis and reduce the occurrence of serious complications.
引文
1 Radmanesh F,Nejat F,El Khashab M,et al.Dermal sinus tract of the spine[J].Childs Nerv Syst,2010,26(3):349-357.DOI:10.1007/s00381-009-0962-z.
2 De Vloo P,Lagae L,Sciot R,et al.Spinal dermal sinuses and dermal sinus-like stalks analysis of 14 cases with suggestions for embryologic mechanisms resulting in dermal sinus-like stalks[J].Eur J Paediatr Neurol,2013,17(6):575-584.DOI:10.1016/j.ejpn.2013.04.003.
3原壮,薛辛东.儿科急重症与疑难病例诊治评述[M].北京:人民卫生出版社,2002:282-285.Yuan Z,Xue XD.Diagnosis and treatment of acute,critical and doubtful diseases in children[M].Beijing:People's Medical Publishing House,2002:282-285.
4 Yamaguchi S,Takeda M,Kihara H,et al.Lateral buttock congenital dermal sinus tract[J].Neurol Med Chir(Tokyo),2011,51(6):460-462.
5 Mrowczynski OD,Lane JR,Shoja MM,et al.Double dermal sinus tracts of the cervical and thoracic regions:a case in a 3-year-old child and review of the literature[J].Child's Nervous System,2018,34(5):987-990.DOI:10.1007/s00381-017-3707-4.
6 Ansari S,Andrabi Y,El Khashab M,et al.Triple lumbar dermal sinuses:unusual presentation of a typically solitary midline lesion[J].Pediatr Neurosurg,2009,45(4):305-307.DOI:10.1159/000235605.
7 Jindal A,Mahapatra AK.Spinal congenital dermal sinus:an experience of 23 cases over 7 years[J].Neurol India,2001,49(3):243-246.
8 Elton S,Oakes WJ.Dermal sinus tracts of the spine[J].Neurosurg Focus,2001,10(1):e4.
9 Schenk JP,Herweh C,Gunther P,et al.Imaging of congenital anomalies and variations of the caudal spine and back in neonates and small infants[J].Eur J Radiol,2006,58(1):3-14.DOI:10.1016/j.ejrad.2005.12.004.
10 Unsinn KM,Geley T,Freund MC,et al.US of the spinal cord in newborns:spectrum of normal findings,variants,congenital anomalies and acquired diseases[J].Radiographics,2000,20(4):923-938.DOI:10.1148/radiographics.20.4.g00jl06923.
11 Kaufman BA.Neural tube defects[J].Pediatr Clin North Am,2004,51(2):389-419.DOI:10.1016/S0031-3955(03)00207-4.
12 Van Aalst J,Beuls EA,Cornips EM,et al.Anatomy and surgery of the infected dermal sinus of the lower spine[J].Childs Nerv Syst,2006,22(10):1307-1315.DOI:10.1007/s00381-006-0106-7.
13甄海宁,章翔,张剑宁,等.脊髓拴系综合征的显微外科治疗[J].第四军医大学学报,2004,25(2):176-178.DOI:10.3321/j.issn:1000-2790.2004.02.025.Zhen HN,Zhang X,Zhang JN,et al.Microsurgical treatment of tethered cord syndrome[J].Fourth Mil Med Univ,2004,25(2):176-178.DOI:10.3321/j.issn:1000-2790.2004.02.025.
14王贤书,张晓茹,曹红宾.900例小儿脂肪瘤型脊髓拴系综合征手术与疗效分析[J].临床小儿外科杂志,2015,14(4):266-270.DOI:10.3969/j.issn.1671-6353.2015.04.004.Wang XS,Zhang XR,Cao HB.Infantile lipoma of tethered cord syndrome:clinical classification,surgical intervention and the evaluation of neural function[J].J Clin Ped Sur,2015,14(4):266-270.DOI:10.3969/j.issn.1671-6353.2015.04.004.
2 De Vloo P,Lagae L,Sciot R,et al.Spinal dermal sinuses and dermal sinus-like stalks analysis of 14 cases with suggestions for embryologic mechanisms resulting in dermal sinus-like stalks[J].Eur J Paediatr Neurol,2013,17(6):575-584.DOI:10.1016/j.ejpn.2013.04.003.
3原壮,薛辛东.儿科急重症与疑难病例诊治评述[M].北京:人民卫生出版社,2002:282-285.Yuan Z,Xue XD.Diagnosis and treatment of acute,critical and doubtful diseases in children[M].Beijing:People's Medical Publishing House,2002:282-285.
4 Yamaguchi S,Takeda M,Kihara H,et al.Lateral buttock congenital dermal sinus tract[J].Neurol Med Chir(Tokyo),2011,51(6):460-462.
5 Mrowczynski OD,Lane JR,Shoja MM,et al.Double dermal sinus tracts of the cervical and thoracic regions:a case in a 3-year-old child and review of the literature[J].Child's Nervous System,2018,34(5):987-990.DOI:10.1007/s00381-017-3707-4.
6 Ansari S,Andrabi Y,El Khashab M,et al.Triple lumbar dermal sinuses:unusual presentation of a typically solitary midline lesion[J].Pediatr Neurosurg,2009,45(4):305-307.DOI:10.1159/000235605.
7 Jindal A,Mahapatra AK.Spinal congenital dermal sinus:an experience of 23 cases over 7 years[J].Neurol India,2001,49(3):243-246.
8 Elton S,Oakes WJ.Dermal sinus tracts of the spine[J].Neurosurg Focus,2001,10(1):e4.
9 Schenk JP,Herweh C,Gunther P,et al.Imaging of congenital anomalies and variations of the caudal spine and back in neonates and small infants[J].Eur J Radiol,2006,58(1):3-14.DOI:10.1016/j.ejrad.2005.12.004.
10 Unsinn KM,Geley T,Freund MC,et al.US of the spinal cord in newborns:spectrum of normal findings,variants,congenital anomalies and acquired diseases[J].Radiographics,2000,20(4):923-938.DOI:10.1148/radiographics.20.4.g00jl06923.
11 Kaufman BA.Neural tube defects[J].Pediatr Clin North Am,2004,51(2):389-419.DOI:10.1016/S0031-3955(03)00207-4.
12 Van Aalst J,Beuls EA,Cornips EM,et al.Anatomy and surgery of the infected dermal sinus of the lower spine[J].Childs Nerv Syst,2006,22(10):1307-1315.DOI:10.1007/s00381-006-0106-7.
13甄海宁,章翔,张剑宁,等.脊髓拴系综合征的显微外科治疗[J].第四军医大学学报,2004,25(2):176-178.DOI:10.3321/j.issn:1000-2790.2004.02.025.Zhen HN,Zhang X,Zhang JN,et al.Microsurgical treatment of tethered cord syndrome[J].Fourth Mil Med Univ,2004,25(2):176-178.DOI:10.3321/j.issn:1000-2790.2004.02.025.
14王贤书,张晓茹,曹红宾.900例小儿脂肪瘤型脊髓拴系综合征手术与疗效分析[J].临床小儿外科杂志,2015,14(4):266-270.DOI:10.3969/j.issn.1671-6353.2015.04.004.Wang XS,Zhang XR,Cao HB.Infantile lipoma of tethered cord syndrome:clinical classification,surgical intervention and the evaluation of neural function[J].J Clin Ped Sur,2015,14(4):266-270.DOI:10.3969/j.issn.1671-6353.2015.04.004.