脊髓髓内肿瘤的显微外科治疗分析

目的探讨髓内肿瘤的临床特点和显微手术疗效,提高早期诊断水平,改善预后。方法回顾性分析2000年3月至2012年8月在华中科技大学同济医学院附属同济医院神经外科经手术治疗并证实为髓内肿瘤的165例患者临床资料。统计学分析采用SPSS 17.0统计分析软件,年龄用均数±标准差(x珋±s)表示,肿瘤定位及病理类型比较采用χ2检验。结果 165例患者共发现171个肿瘤,男性患者肿瘤好发于颈段,女性好发于胸段(χ2=11.97,P0.05);青少年患者病理类型主要为星形细胞瘤,成年患者主要为室管膜瘤(χ2=86.50,P0.001);术前MRI定位诊断准确率97.5%,定性诊断准确率96.4%。术前Mc-Cormick分级Ⅰ级48例,Ⅱ级85例,Ⅲ级21例,Ⅳ级11例。手术采用椎板切开显微切除肿瘤,辅助术中神经电生理监测和术后综合治疗,术后早期随访Mc-Cormick分级判断疗效,术后Ⅰ级139例,Ⅱ级20例,Ⅲ级1例,Ⅳ级5例,症状缓解率96.4%,其中症状完全恢复者139例(84.2%),大部分好转恢复者20例(12.1%),症状同前4例(2.4%),肢体运动功能恶化2例(1.2%)。结论髓内肿瘤起病缓慢,早期症状隐匿易被忽视和误诊,术前MRI定位和定性诊断准确性和特异性高,为早期诊断提供了保证。显微手术切除是治疗髓内肿瘤唯一可靠有效的治疗手段,尤其是近两年来使用神经电生理监测指导显微手术,极大地提高了手术全切率和预后。

The microscopic tumorectomy of patients with intramedullary spinal cord tumor

Objective To explore the clinical characteristics and effect of microscopic tumorectomy of intramednllary spinal cord tumors, in order to improve diagnosis and prognosis. Methods One hundred and sixty-five patients of intrameduUary spinal cord tumors confirmed by microsurgery from March 2000 to August 2012 were analyzed retrospectively. Statistical analysis was performed by using SPSS 17.0 statistical analysis software, age was expressed by x^-±s, the tumor location and histological type were compared by using Х^2 test. Results There were 171 tumors observed in 165 patients. The most frequency of tumor location was cervical cord in man and thoracic cord in woman （Х^2 = 11.97, P 〈 0. 05 ）. Also the tumor pathological type was ependymoma in elder patients（ age ≥ 18-year-old）and astrocytoma in younger patients（ age 〈 18-year- old） （Х^2 = 86. 50, P 〈 0. 001 ）. Preoperative spinal MRI could locate the qualitative diagnosis with high accuracy rate of 97.5% and 96. 4%. Preoperative Mc-Cormick clinical function classification：48 belonged to grade Ⅰ ,85 to grade Ⅱ ,21 to gradeⅢ,11 to gredelV. The laminotomy and microscopic tumor resection were performed in all patients accompanied with intraoperative neurophysiological monitoring and postoperative treatment. The prognosis was assessed in 2-3 months＇ follow-up, according to the postoperative Mc-Cormick clinical function classification,139 belonged to grade Ⅰ ,20 belonged to grade Ⅱ, 1 belonged to grade Ⅲ, 5 belonged to gradeⅣ. In all the patients, about 84. 2% of which got full-recovery, 12. 1% got neurological function improved,2. 4% unchanged, 1.2% were worse. Conclusions The slow progress and tong disease course of intramedullary spinal cord tumors result in the missed diagnosis and misdiagnosis. Spine MRI can provide high accuracy of tumor information in order to make sure the early diagnosis. The microscopic resection of tumors is the only way to cure this disease. Especially the use of intraoperative neurophysiological monitoring can make sure the completely tumor resection in order to improve the outcome.