[1]张杨,薛兴森,何光建,等.基于一期全切除策略的椎管内外沟通性肿瘤手术新分型(附133例临床分析)[J].临床神经外科杂志,2020,17(04):361-365.[doi:DOI:10.3969/j.issn.1672-7770.2020.04.001]
 ZHANG Yang,XUE Xing-sen,HE Guang-jian,et al.New surgical classification of intraspinal and extraspinal communicating tumors based on one-stage total resection strategy(report of 133 cases)[J].Journal of Clinical Neurosurgery,2020,17(04):361-365.[doi:DOI:10.3969/j.issn.1672-7770.2020.04.001]
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基于一期全切除策略的椎管内外沟通性肿瘤手术新分型(附133例临床分析)()
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
17
期数:
2020年04期
页码:
361-365
栏目:
脊柱脊髓专题
出版日期:
2020-08-14

文章信息/Info

Title:
New surgical classification of intraspinal and extraspinal communicating tumors based on one-stage total resection strategy(report of 133 cases)
文章编号:
202004001
作者:
张杨薛兴森何光建陈欣刘静静张洪燕冯华林江凯储卫华
400038 重庆,陆军军医大学第一附属医院(西南医院),全军神经外科研究所
Author(s):
ZHANG Yang XUE Xing-sen HE Guang-jian et al.
Department of Neurosurgery, the First Affiliated Hospital of the Army Military Medical University, Chongqing 400038, China
关键词:
椎管内外沟通性肿瘤分型一期手术脊柱稳定性内固定
Keywords:
intraspinal and extraspinal communicating tumors classification one-stage operation spinal stability internal fixation
分类号:
R739.42
DOI:
DOI:10.3969/j.issn.1672-7770.2020.04.001
文献标志码:
A
摘要:
目的 探讨椎管内外沟通性肿瘤一期全切除策略,建立其手术新分型。方法 根据各手术入路可暴露的范围,将椎管内外沟通性肿瘤分成2型5类:Ⅰ型为肿瘤横跨椎管内、椎间孔、椎间孔外三个区域;Ⅱ型为肿瘤只占据椎间孔及椎间孔外两个区域。按轴位上椎间孔外肿瘤的直径大小,将Ⅰ型分为3个亚型:Ⅰa型(直径<2 cm),采用后正中入路;Ⅰb型(直径2~6 cm),后路弧形切口入路;Ⅰc型(直径>6 cm),联合入路。将Ⅱ型分为两个亚型:Ⅱa型(直径≤6 cm),旁正中肌间隙入路;Ⅱb型(直径>6 cm),侧前方入路。并对133例椎管内外沟通性肿瘤按新分型进行手术治疗。结果 肿瘤一期全切131例,全切率为98.5%。单一切口126例,占94.7%。肿瘤病理类型以神经鞘瘤为多,共98例(73.7%)。恶性肿瘤6例,其中2例患者未能镜下全切。因肿瘤破坏及手术切除骨质而引起脊柱不稳一期行内固定的患者42例(31.6%)。术后122例患者(91.7%)的症状明显改善;7例患者的症状无明显变化;4例患者出现神经损害症状加重,包括局部感觉减退、部分肌肉肌力下降,但日常活动能够自理。结论 椎管内外沟通性肿瘤的手术新分型在一期全切肿瘤的基础上,兼顾了脊柱稳定性的保护,具有简单实用、手术指导性强的优点。
Abstract:
To explore the strategies of one-stage total resection for intraspinal and extraspinal communicating tumors(IESCTs) and establish a new surgical classification. Methods According to the exposure range of each operative approach, IESCTs were divided into 2 types and 5 subtypes. TypeⅠ invaded spinal canal, foramen and extra foramen on axial plan. TypeⅡ only occupied foramen and extra foramen. Furthermore,in the light of the diameter of extraforaminal tumors, typeⅠwas divided into three subtypes: Ⅰa, the diameter of the extraforaminal tumors less than 2 cm , suitable for posterior median approach, Ⅰb, the diameter between 2 cm and 6 cm, suitable for posterior arc incision and Ⅰc, the diameter more than 6 cm, suitable for combined approach. Type Ⅱ was divided into two subtypes: Ⅱa,the diameter of the extraforaminal tumors less than 2 cm,suitable for paramedian approach(<6 cm) and Ⅱb, the diameter more than 6 cm, suitable for anterior approach. Total 133 cases of IESCTs were operated using the approaches of the new classification. ResultsOne stage total resections were performed in 131 cases with a total resection rate of 98.5%. The most common pathological type in this series was Schwannoma that confirmed in 98 cases(73.7%). 42 (31.6%) were treated with one-stage internal fixation to rectify spinal instability caused by tumor destruction and surgical resection. There were 122 cases (91.7%) with improved symptoms after surgery, and 7 had no change in postoperative symptoms. Four cases with aggravated symptoms after operation, including local hypoesthesia and muscle weakness, were still able to walk freely. ConclusionThe new classification of IESCTs is simple and practical, while guiding the one stage of total resection tumors also takes into account the protection of spinal stability.

备注/Memo

备注/Memo:
作者简介:储卫华,陆军军医大学第一附属医院(西南医院)副主任医师,医学博士,硕士研究生导师,美国匹兹堡大学医学中心访问学者。中华医学会神经外科分会脊柱脊髓学组委员,中国医师协会多模态影像技术与神经修复委员会副主任委员,重庆市医学会神经外科分会脊柱脊髓学组副组长,中国医促会加速康复外科分会委员,世界华人神经外科协会脊柱脊髓专业委员会委员,中国医师协会神经发育畸形修复专家委员会委员,中国研究型医院学会脊髓脊柱委员会青年委员。擅长脊髓脊柱肿瘤及创伤、颅颈交界区及脊柱畸形、椎间盘突出症、椎管狭窄、骶管囊肿、脊髓拴系等的手术治疗。对听神经瘤、岩斜区肿瘤、脑干肿瘤等颅底外科亦有较丰富的经验。承担国家军口"863"项目、国家自然科学基金等各类课题7项,总经费约300万。提交《中国国防科技报告》12部、涉密论文18篇;发表SCI论文10余篇、中文论文20余篇;获重庆市科技进步一等奖、军队科技进步二等奖各1项;第一完成人获得国家发明专利1项、大学临床新技术奖2项。
更新日期/Last Update: 2020-08-17