脊髓髓内胶质瘤的显微外科治疗

目的 探讨运用显微外科技术切除脊髓髓内室管膜瘤和星形细胞瘤的手术技术和临床效果. 方法 对近3年来我科手术治疗的11例资料完整的脊髓髓内胶质瘤患者进行回顾性分析,采用McCormick临床神经功能分级方法 和MRI影像检查评估手术疗效. 结果 6例室管膜瘤全切除5例,次全切除1例;5例星形细胞瘤,2例全切除,3例大部分切除.术后近期临床神经功能改善4例,保留术前神经功能5例,较术前神经功能加重2例.随访3个月-3年,6例室管膜瘤无1例复发,其中1例次全切除患者进行了放疗;5例星形细胞瘤术后均进行了放化疗,2例大部分切除患者2年后临床症状又进行性加重,MRI提示肿瘤复发. 结论 显微神经外科操作技术是切除脊髓髓内胶质瘤的有效措施之一,选择适时进行手术达到既能全切除肿瘤又能保证患者的临床神经功能 ,提高生存质量.

Microsurgery in treatment of intramedullary spinal cord gliomas

Objective To explore the effect of microsurgey in treatment of intramedullary spinal cord ependymomas and astrocytoma.MethodsThe clinical data of 11 patients with intramedullary spinal cord gliomas resected by microsurgey were analyzed retrospectively.The effect of microsurgery was evaluated by the clinical functional classification of McCormick and MRI.ResultsTotal resection was achieved in 5 of 6 patients with ependymomas and subtotal resection in 1 patient.Total resection was accomplished in 2 of 5 patients with astrocytomas,and partial resection in 3 patients.After operation,neurological function was improved in 4 cases,not changed in 5 cases,and aggravated in 2 cases.After followup for 3 months to 3 years,there was no recurrence in the 6 cases with ependymomas,of which,one with partial resection accepted radiotherapy.Five cases with astrocytomas accepted radiotherapy and chemotherapy after operation,2 cases were found in recurrence after two years and clinical symptom aggravated gradually.MRI revealed the recidivation of tumor.ConclusionThe microsurgery is one of the effective measures for cutting off the intramedullary tumor,which can achieve total resection,ensure the patient's neurological function,and enhance the quality of life.