人纤维蛋白粘合剂封闭囊肿术治疗症状性骶管囊肿

目的 探讨经皮穿刺人纤维蛋白粘合剂封闭囊肿术治疗症状性骶管囊肿的疗效。方法 回顾分析2005年1月～2009年12月本院收治的采用CT引导下经皮穿刺抽吸囊液,人纤维蛋白粘合剂封闭囊肿术治疗的症状性骶管囊肿患者资料38例。其中男15例,女23例;年龄21～76岁,平均50岁。初发病例27例,再发11例。囊肿部位:L₅/S₁ 11例,S₁/S₂ 16 例,S₂/S₃ 7 例,骶前4例。经MRI检查均确诊为骶管囊肿。采用Oswestry功能障碍指数(Oswestry disability index,ODI)和疼痛视觉模拟量表(visual analogue scale, VAS)评分评估患者术后3个月、1年、5年腰骶区疼痛、麻木和功能改善情况。结果 所有患者均顺利完成手术, 手术时间(42.2±16.0) min,术中出血量(25.8±20.4) mL。38例均获随访,随访时间27～96个月,平均63个月。患者术后ODI和VAS评分均较术前明显改善,差异具有统计学意义(P< 0.01)。术后复查MRI, 患者囊腔消失29例(76.3%),囊腔缩小4例(10.5%),囊肿无缩小5例(13.2%)。结论 微创治疗症状性骶管囊肿具有创伤小、出血少、疗效佳、恢复快等优点,对于初发或开放手术术后再发的患者均有效果,是治疗骶管囊肿的良好方法。

Efficacy of minimally invasive for symptomatic sacral canal cyst by fibrin glue

Objective To evaluate the efficacy of the minimally invasive treatment of sacral canal cyst using fibrin glue. Methods From January 2005 to December 2009, 38 cases of diagnosed of sacral canal cyst with C-arm or the CT-guided percutaneous fibrin glue therapy of arachnoid cysts. There were 15 males and 23 females, aging from 21-76 years with an average of 50 years. L₅/S₁ was involved in 11 cases, S₁/S₂ in 16 cases, S₂/S₃ in 7 cases and pre-sacral in 4 cases. All the patients diagnosed with verified cysts in the sacral canal with MRI examination. Lumbar-sacral pain and numbness remission and function improvement were evaluated with visual analogue scale(VAS) score and Oswestry disability inder(ODI) after 3 months, 1 year, and 5 years. Results The operation time and blood loss were (42.2±16.0) min, (25.8±20.4) mL, respectively. All the patients were followed up from 27 to 96 months (mean 63 months). The ODI and VAS score were significantly improved after operation (P< 0.01). Postoperative MRI showed cyst disappearance in 29 patients, cystic space narrowing in 4 paitents. Most patients experienced benefit from the procedure: 20 cases (52.6%) reported excellent recovery with signs and symptoms disappeared completely, 9 (23.7%) reported good recovery with symptoms partially remitted, 4 (10.5%) reported fair recovery, and 5 (13.2%) reported poor recovery. Conclusions Minimally invasive treatment for symptomatic sacral arachnoid cysts have good effects for both primary and recurrent patients. And it is a good choice for the treatment of arachnoid cysts in the sacral canal, as it has the advantages of minimal trauma, less bleeding, good curative effect, and rapid recovery.