上腔静脉瘤（附一例报告）

目的:提高对罕见病上腔静脉瘤的认识。方法:对1例经手术和病理证实的恶性神经鞘瘤引起的继发性上腔静脉瘤患者的临床资料进行分析,并结合文献复习。结果:上腔静脉瘤早期临床症状少,晚期可出现上腔静脉综合征。CT和超声检查可显示上腔静脉瘤的范围、大小、形态以及有无血栓形成。螺旋CT血管造影可显示平面和立体图像。结论:上腔静脉瘤的形成必须是管腔局限性扩大于邻近正常管腔一倍以上。     

后腹腔镜下腹膜后神经鞘瘤切除术27例报告

目的:应用后腹腔镜技术治疗腹膜后神经鞘瘤,探讨其安全性和可行性.方法:本组27例患者均经腹膜后途径腹腔镜下切除腹膜后神经鞘瘤.B超检查偶然发现18例、血压升高4例、腰腹部酸疼5例.血肾上腺素、去甲肾上腺素升高1例.27例均行B超及CT检查,其中22例同时行MRI检查.肿瘤位于左侧肾上腺周围9例、右侧肾上腺周围7例、左肾下极2例、右肾下极2例、腹主动脉旁2例、下腔静脉旁5例.结果:其中26例获得成功,肿瘤直径1.55～5.0 cm,平均3.4 cm;手术时间45～105 min,平均60 min;出血量15～110 ml.平均65ml.腹膜损伤1例,中转开放手术,无后遗症.无损伤大血管及大出血及膈肌损伤病例,无输血病例.结论:后腹腔镜下切除腹膜后神经鞘瘤,手术出血少、创伤小、患者恢复快,在选择合适病例的前提下,是切除腹膜后神经鞘瘤的一种较好方法.     

人工神经鞘管预防周围神经鞘瘤术后刺激性神经痛的临床研究

目的 探讨人工神经鞘管对周围神经鞘瘤切除术后刺激性神经痛的预防作用. 方法 将30例神经鞘瘤患者随机分为人工神经鞘管组和对照组,每组各15例.两组均按照常规方法行肿瘤切除术,人工神经鞘管组行肿瘤切除后神经局部用人工神经鞘管包裹,对照组仅行肿瘤切除术.两组分别于术后3个时间点采用视觉模拟量表(VAS)对疼痛进行量化评分并计算刺激性神经痛发生率,运用统计学方法对数据进行分析. 结果 对照组术后3个时间点疼痛评分分别为7.5、5.1和2.8,疼痛发生率分别为80％、67％和40％;人工神经鞘管组3个时间点疼痛评分分别为3.2、1.5和0,疼痛发生率分别为33％、13％和0.经统计学分析,两组各时间段平均疼痛评分及刺激性神经痛发生率的差异均有统计学意义(P＜0.05). 结论 人工神经鞘管能够显著降低神经鞘瘤切除术后刺激性神经痛的疼痛程度及发生率,是临床预防刺激性神经痛实用、有效的方法.     

A rare cause of chronic sciatic pain: Schwannoma of the sciatic nerve

Schwannomas are common, benign tumors of the shelth of peripheral nerves. Sciatic schwannomas are rare. Their symptomatology usually mimics sciatic pain due to a herniated disc, which can delay the diagnosis. If there is no lumbar pain and lumbar MRI is normal, the sciatic nerve must be clinically and radiologically examined all along its course. We report a case of sciatic nerve schwannoma presenting with chronic sciatica which was diagnosed and monitored radiologically for several years before successful surgical resection.     

腹膜后良性神经鞘瘤的影像学特征

目的分析腹膜后良性神经鞘瘤的 CT 和 MRI 表现,总结其影像学特征.资料与方法经手术病理证实的27例腹膜后良性神经鞘瘤患者中,21例行多层螺旋 CT 检查,9例行 MRI 检查.观察 CT、MRI 平扫和增强时肿瘤的特征性改变.结果27例腹膜后良性神经鞘瘤边缘规则光整,直径多在5~10cm之间,CT 平扫肿瘤呈实性或囊实性.CT 增强后动脉期轻至中度强化10例,主要呈云絮状、索条状强化;动脉期9例可见纤细血管显影.门脉期及延迟扫描轻度渐进性强化13例.MRI 平扫呈不均匀长 T1长 T2影,DWI 呈高信号,4例可见靶征改变,增强后门脉期及延迟呈渐进性强化.无一例发生淋巴结转移.结论腹膜后良性神经鞘瘤影像学表现具有一定特异性,CT 结合 MRI 检查及多期增强扫描对其诊断有一定价值.     

Large foot schwannoma with bone invasion – A case report

A rare case of a large foot schwannoma with an intraosseous component is presented. Due to suspicion of malignancy, an amputation had previously been proposed. When the patient presented to us, the prolonged clinical course as well as some elements of the imaging exams suggested benignancy and we decided for complete tumor excision. Intraoperative findings supported the benign character of the neoplasm and pathology would later confirm the diagnosis of a benign schwannoma. The outcome, at 18 months of follow-up was a fully functional limb. Recurrence must still be considered but malignant transformation is very rare in a solitary schwannoma and can be discounted.Solitary benign schwannomas have a negligible malignization potential independently of their size or osseous component. When benignancy is considered, primary total tumor excision, as part of a staged procedure, is a safe approach. It allows for a thorough pathologic examination and eventually for a definitive treatment.     

周围神经鞘瘤的显微外科治疗

目的：探讨周围神经鞘瘤显微手术治疗的效果。方法回顾性分析54例经显微手术切除神经鞘瘤的疗效。结果本组54例均取得良好效果。经过1～2年的随访,5例恶性神经鞘瘤无复发;良性神经鞘瘤,1例术后出现皮肤感觉麻木,3例出现运动功能障碍,6个月后基本恢复。结论周围神经鞘瘤经显微手术治疗可最大限度地降低神经的损伤,可最大程度地完整切除肿瘤,对于恶性神经鞘瘤,扩大切除可降低复发。     

Intraosseous neurilemmoma of the fibula

 We present a case of intraosseous neurilemmoma of the fibula in a 56-year-old woman. This case showed the typical radiographic appearance except for the presence of spotted calcifications that mimicked a cartilaginous tumor. Enhanced MR images revealed the heterogeneity of the tumor, which consisted of Antoni type A and B tissue.     

眼眶内神经鞘瘤的临床病理分析

本文报告了眼眶内神经鞘瘤１６例，均经手术切除及病理检查证实，其中男性６例，女性１０例。发病年龄４—７０岁，平均４０岁。病程１月—５年。右眼１０例，左眼６例。视力０．１—０．５者４例；＞０．５者８例，＜０．１者４例。突眼者１２例，两眼突出度差值最大２３ｍｍ，最小２．５ｍｍ。病理组织学检查：ＡｎｔｏｎｉＡ型８例，ＡｎｔｏｎｉＢ型４例，混合型４例。本文还对眶神经鞘瘤的临床表现、病理特征以及鉴别诊断作了简要的讨论。     

Differences on intraoperative ultrasonography between meningioma and neurilemmoma

We examined the differences on intraoperative ultrasonography between 17 cases of meningioma and 29 of neurilemmoma, the common intradural extramedullary tumors. In meningiomas, cysts were rarely seen (in 12.5 %, P < 0.01 %) and echogenicity was high (in 82.3 %, P < 0.01 %). In neurilemmoma, many cysts were seen (72.5 %) and low echoes tended to be more common (72.4 %, P < 0.01 %). In the neurilemmomas with high or isoechogenicity, Antoni A types, histologically rich in collagen fibres, predominanted.