骶部硬膜外囊肿的临床影像学表现与外科治疗(18例报告及文献综述)

目的]结合文献探讨骶部硬膜外囊肿（SEC）的临床表现、影像学特点与外科治疗，以便提高对该病的临床诊断和治疗水平。方法]本组18例，其中腰骶部钝痛17例（95％）、下肢放射性疼痛和间歇性跛行16例（90％）、神经功能损害14例（77％）、盆腔或下腹部无痛渐进性肿块并压迫临近器官2例（11％）。18例均行腰骶部及骨盆X线片检查，其中17例行CT扫描、11例行MRI检查、7例行脊髓造影、4例行CTM扫描。结果]本病临床误诊率为78％，X线诊断率17％，CT诊断率72％；MRI检查、脊髓造影、CTM扫描诊断率100％。18例均手术切除，病理报告为硬膜外囊肿，椎管内型、积液型、单发囊肿为多数；随访15～32个月，平均24个月，未发现症状加重和复发病例。结论]骶部硬膜外囊肿临床与影像学具有特征性表现；微创术和腹腔镜、脊髓或椎管镜摘除骶椎管内囊肿的临床应用疗效有待于定论；显微外科技术的应用提高了SEC全切除率，手术是治疗和防止本病复发的最主要和最可靠方法。

Manifestation of clinical imageology and surgical treatment of the sacral epidural cystis (18 cases and literature summary)

Objective]To analyze the clinical diagnosis and therapic level,the clinical manifestation,image manifestation and surgical treatment of the sacral epidural cystis.Method]Eighteen cases with the sacral epidural cystis were analyzed retrospectively,17 cases(95%)with dull pain of the lumbosacral area,16 cases(90%)with radiated pain of the lower limbs and intermittent limping,14 cases(77%)with functional lesion of the nerves,2 cases(11%)with tumor of pelvic,cavity or hypogastrium.All of them were taken AP views of X-ray,17 cases taken two-dimentional CT scannings,11 cases taken MRI,7 cases taken myelography and 4 cases taken CTM scannings.Result]The rate of the error diagnosis was 78% in the clinic,while the success diagnosis rate was 17% in the X-ray,72% in the CT,100% in the MRI,myelography and CTM.The exairesis were done in all the 18 cases,and the epidural cystis were diagnosed in pathology.No reoccurrance was found at 15~32 months follow-up.Conclusion]There are characteristic changes in the imageology and clinic of the sacral epidural cystis.Using minimall invasive surgery(laparoscope vertebroscope and epiduroscopy)has no confirm result till now.Microsurgical techniques contribute to the improvement of the total removal rates for the intraspinal tumors.So operation is reliable method to treat this disease and to prevent its recurring.