椎旁肌间隙入路显微切除椎旁肿瘤的临床应用（附9例报告）

目的：总结椎旁肌间隙入路(Wiltse入路)在切除椎旁肿瘤中的应用、疗效及优点。 方法：以手术治疗的9例胸腰椎椎旁肿瘤病人（男性6例，女性3例）为研究对象。9例术前均完善MR/CT检查，术中C臂机定位，采用Wiltse入路行肿瘤切除。并于术后第三日，术后三个月及九个月复查MR。平均住院时间5天，所有患者随访4 -10个月，平均随访时间8个月。 结果：9例术后病理均为神经鞘瘤。症状均有明显改善。9例切口均一期愈合,无感染,术后复查MR肿瘤切除满意。随访患者无肿瘤复发,神经功能活动未受影响。 结论：Wiltse入路充分利用肌肉间自然间隙，能更好的保护椎旁组织，减少术后并发症，提高手术疗效，值得在神经外科椎旁肿瘤等手术中运用。

Clinical application of Wiltse approach in the resection of paravertebral tumors(report of 9 cases)

Objective To summarize the curative effect and advantage of Wiltse approach in the operation of paraspinal tumor resection. Methods 9 patients (6 males and 3 females) who were underwent the operation of thoracolumbar paravertebral tumor resection with Wiltse approach were selected in this study. The image of CT or MRI was prepared before the operation. With the help of intraoperative location by C-arm fluoroscopy, we removed the tumor. And then we followed up the patients from 4 to 10 months(average time was 8 months) and reviewed the image of Post-MRI after surgery to investigate the effect at three days three months and nine months respectively.Results All 9 patients tumor had been certified to schwannoma. And the symptoms were all improved significantly. The incisions of all 9 cases were healed by first intention without infection. The image of Post-MRI proved that all the tissue of tumor has been removed satisfactory. The average hospitalization time is 5 days. No recurrence of tumors and unaffected neurofunctional activity was appeared in follow-up patients .Conclusion Wiltse approach surgery take full advantage of the natural gap between muscle, protect vertebral tissues better, and reduce the rates of postoperative complications, it is worthy to be spread in the operation of paraspinal tumor in neurosurgery.