原发性椎管内淋巴瘤的诊治——附6例临床分析

背景与目的：原发性椎管内淋巴瘤十分罕见，本研究旨在总结原发椎管内淋巴瘤的临床特点，影像学特征及治疗手段，以提高对此病的认识。方法：对北京天坛院神经外科三病房2000年1月至2006年12月间收治的6例经病理证实为椎管内恶性淋巴瘤的患者进行回顾性分析，并文献复习。结果56例患者中，男性4例，女性2例，中位年龄38．5岁。4例患者首发症状为疼痛，平均病程10．9个月。所有患者术前均行MRI检查．肿瘤位于颈段4例，胸段1例，骶段1例。本组患者均采取显微手术治疗，术中辅以电生理监测，肉眼全切1例，近全切除4例，大部分切除1例，无手术死亡。术后4例症状缓解，出院后全部患者均行放射治疗．效果满意。结论：原发性椎管内淋巴瘤是椎管内的罕见肿瘤，缺乏特异性的影像学表现。椎板切除减压，肿瘤切除．术后辅以局部放疗和全身化疗是其主要治疗手段．预后较好。

Diagnosis and Treatment of Primary Intraspinal Lymphomas:Report of 6 Cases

BACKGROUND & OBJECTIVE: Primary intraspinal lymphomas are rare,this study is to investigate clinical manifestations,imaging and management of primary intraspinal lymphomas. METHODS: Six cases of pathologically confirmed primary intraspinal lymphoma,treated in the 3rd ward of department of Neurosurgery,Beijing Tiantan Hospital,from January of 2000 to December of 2006 were retrospectively analyzed. RESULTS: Among the 6 patients,there were 4 men and 2 women with an average age of 38.2 years old. Pain was the initial symptom in 4 patients. The average course of disease was 10.9 months. All the patients were examined by preoperative MRI scan. There were 4 tumors located in cervical segment,1 tumor in thoracic segment and 1 located in sacral segment. Intraoperative electrophysiologic monitoring was adopted. Total resection under naked eye was achieved in 1 case,subtotal removal in 4 cases,and partial removal in 1 case. There was no surgical death. Symptomatic was attained in 4 patients,radiotherapy was performed on all patients after surgery. CONCLUSIONS: Primary intraspinal lymphomas are rare intraspinal tumors without specific imaging features. Laminectomy,tumor resection,post-operative radiotherapy and chemotherapy are main treatment modalities. The prognosis is relatively good.