椎管内肿瘤的诊断与治疗

目的总结椎管内肿瘤的诊断与治疗经验。方法回顾性分析1992~2003年收治的123例椎管内肿瘤的治疗结果。结果脊膜瘤24例(19.5%),神经鞘瘤/神经纤维瘤32例(26.0%),室管膜瘤8例(6.5%),星形细胞瘤13例(10.6%),脂肪瘤10例(8.1%),转移瘤5例(4.1%),血管瘤5例(4.1%),蛛网膜囊肿9例(7.3%),其他17例(13.8%)。其中髓外硬膜内占56.1%,硬膜外占21.1%,髓内占22.8%。颈段30.1%,胸段37.4%,腰段19.5%,骶段13.0%。髓外肿瘤70.1%,髓内肿瘤60.7%。全切除率69.1%。运动改善率75.2%,感觉障碍改善73.8%,括约肌功能改善77.8%。结论椎管内肿瘤以良性居多,手术效果好,MRI检查和显微外科技术的应用是提高治疗效果的关键。如果术中破坏了脊柱的稳定性,重建稳定性非常必要。

Diagnosis and treatment of intraspinal tumors

Objective To summarize the experiences of the diagnosis and treatment of the intraspinal tumors. Methods One hundredand twenty-three cases of the intraspinal tumors were analyzed retrospectively. Results The intraspinal tumors in those patients included meningiomas/neurofibroma in 32 cases (19.5%), neurinoma in 32 cases (26.0%), ependymoma in 8 cases (6.5%), astrocytoma in 13 cases (10.6%), lipoma in 10 cases (8.1%), metastatic tumors and hemangioma each in 5 cases (4.1%), arachnoid cyst in 9 cases (7.3%), and others in 17 cases (13.8%). The extramedullary subdural, epidural and intramedullary tumors accounted for 56.9%, 21.1% and 22.8%. According to the locations, 30.1% tumors located at cervical region, 37.4% at thoracic region, 19.5% at lumbar region and 13.0% at sacral segments. The total removal rates of tumors were 69.1% (the total removal rates of extramedullary tumors were 70.1%, and the removal rates of intramedullary tumors were 60.7%).The improvement rates of different degree of movement, sense and sphincter function were 75.2%, 73.8% and 77.8%. Conclusion Most of the intraspinal tumors are benign, and the surgical outcome is satisfied. The keys of therapeutic efficacy were MRI and microsurgical techniques application. The spinal stability reconstruction is in the extreme need if spinal stability is breached in surgery.