Wen Haitao,Wu Shuihua,Chen Chaohui,et al.Improvements of spinal cord compression symptoms after microsurgical removal of intraspinal tumors in children[J].Journal of Clinical Pediatric Surgery,2019,18(11):973-976,983.[doi:10.3969/j.issn.1671—6353.2019.10.015]
小儿椎管内肿瘤显微切除术后疗效分析
- Title:
- Improvements of spinal cord compression symptoms after microsurgical removal of intraspinal tumors in children
- Keywords:
- Spinal Canal/SU; Microsurgery; Spinal Cord Compression; Treatment Outcome; Child
- 分类号:
- R726.1;R651.2
- 摘要:
- 目的 探讨椎管内肿瘤显微切除术对患儿脊髓压迫症状的改善情况。方法 选取湖南省儿童医院2018年2月至2019年1月收治并实行显微切除术的椎管内肿瘤患儿3例,记录其临床症状、基本体征、影像学表现、病理类型等数据。观察患儿术前、术后肢体疼痛麻木、乏力等脊髓压迫症状的改善情况。结果 病理检查结果显示:3例椎管内肿瘤患儿中神经鞘瘤1例,神经母细胞瘤2例。肿瘤全部切除2例,部分切除1例。术后患儿下肢乏力均得到缓解,疼痛麻木缓解1例,无一例无严重并发症或死亡病例。结论 采用显微切除术治疗小儿椎管内肿瘤能够有效改善患儿脊髓压迫症状,患儿总体预后良好,并发症少。
- Abstract:
- Objective To explore the improvements of spinal cord compression symptoms in children after intraspinal tumor microsurgery.Methods A total of 3 children with intraspinal tumor underwent microsurgical resection from February 2018 to January 2019.Their clinical symptoms,basic signs,pathological types and surgical outcomes were recorded.And observations were made about the occurrence of spinal cord compression symptoms such as radiculopathy,sensory disturbance,dyskinesia,rectal and bladder dysfunction.Results Histopathological analysis of intramedullary tumors revealed Schwannoma (n=1) and neuroblastoma (n=2).Resection was total (n=2) and partial (n=1).All symptoms of spinal cord compression were relieved.One case of pain and numbness improved.Conclusion For children with intraspinal tumors,microsurgical treatment can effectively improve the spinal cord compression symptoms,effectively promote spinal remodeling and improve spinal stability.The overall prognosis is excellent and there are fewer complications.It improves the survival and quality-of-life of children and wider clinical applications are recommended.
参考文献/References:
1 Kawahara N,Tomita K,Murakami H,et al.Total en bloc spondylectomy for spinal tumors:surgical techniques and related basic background[J].Orthop Clin North Am,2009,40(1):47-63.DOI:10.10160.ocl.2008.09.004.
2 李建民,李振峰.中国脊柱肿瘤外科治疗存在问题及面临的挑战[J].中华骨科杂志,2018,38(10):577-579.DOI:10.3760/cma.j.issn.0253-2352.2018.10.001. Li JM,Li ZF.Issues and challenges in surgical treatments of spinal tumors in China[J].Chin J Orthop,2018,38(10):577-579.DOI:10.3760/cma.j.issn.0253-2352.2018.10.001.
3 鲁亚杰,李明辉,龙作尧,等.国人脊柱原发肿瘤流行病学特征的Meta分析[J].中国脊柱脊髓杂志,2018,28(1):62-72.DOI:10.39690.issn.004·406X.2018.01.10. Lu YJ,Li MH,Long ZY,et al.Epidemiological characteristics of primary spinal tumors in China:a Meta-analysis[J].Chin J Spine Spinal Cord,2018,28(1):62-72.DOI:10:39696.issn.1004-406 X.2018.01.10.
4 Tomita K,Kawahara N,Murakami H,et al.Total en blo-cspondy-lectomy for spinal tumors:improvement of the technique and its associated basic background[J].J Orthop Sci,2006,11(1):3-12.DOI:10.10071s00776-005-0964-y.
5 沈慧勇,黄霖,杨睿,等.改良一期后路全脊椎整块切除术治疗胸脊椎肿瘤[J].中华骨科杂志,2011,31(1):7-12.DOI:10.3760/cma.j.issn.0253-2352.2011.01.002. Shen HY,Huang L,Yang R,et al.Modified surgical techniques in total en bloc spondylectomy for thoracic and lumbar tumors with a single posterior approach[J].Chin J Orthop,2011,3l(1):7-12.DOI:10.3760/cma.j.issn.0253-2352.2011.01.002.
6 徐华梓,池永龙,水小龙.经后路全脊椎整块切除术治疗胸脊椎肿瘤[J].中国脊柱脊髓杂志,2009,19(4):268-272.DOI:10.39696.issn.1004·406X.2009.04.07. Xu HZ,Chi YL,Shui XL.Spondylectomny en bloc for thoracic and lumbartumors via Posterior approach[J].Chinese Journal of Spine & Spinal Cord,2009,19(4):268-272.DOI:10.39696.issn.1004-406X.2009.04.07.
7 Tokuhashi Y,Matsuzaki H,Oda H,et al.A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis[J].Spine(Phila Pa 1976),2005,30(19):2186-2191.DOI:10.1097/01.brs.0000180401.06919.a5.
8 郭常安,阎作勤,张键,等.改良全脊椎切除技术后路一期切除胸椎肿瘤[J].中华骨科杂志,2010,30(5):449-453.DOI:10.3760/cma.j.issn.0253-2352.2010.05.002. Guo CA,Yan ZQ,Zhang J,et al.Modified total en bloc spondylectomy for thoracic vertebra tumor through single posterior approach[J].Chin J Orthop,2010,30(5):449-453.DOI:10.3760/cma.j.issn.0253-2352.2010.05.002.
9 Jimbo H,Kamata S,Miura K,et al.En bloc temporal bone resection using a diamond threadwire saw for malignant tumors[J].J Neurosurg,2011,114(5):1386-1389.DOI:10.3171/2010.8.JNSl0294.
10 Chang SH,Park YG,Kim DH,et al.Monitoring of motor and somatosensory evoked potentials during spine surgery:intraoperative changes and postoperative outcomes[J].Ann Rehabil Med,2016,40(3):470-480.DOI:10.5535/arm.2016.40.3.470.
11 Cheng JS,Ivan ME,Stapleton CJ,et al.Intraoperative changes in transcranial motor evoked potentials and somatosensory evoked potentials predicting outcome in children with intramedullary spinal cord tumors[J].J Neurosurg Pediatr,2014,13(6):591-599.DOI:10-3171/2014-2.
12 skinner SA,Vodusek DB.Intraoperative recording of the bulbocavemosus reflex[J].J Clin Neurophysiol,2014,31(4):313-322.DOI:10.1097/WNP.0000000000000054.
13 宋启民,费昶,陈春美.运动诱发电位对兔腹主动脉阻断脊髓损伤的预警[J].中华实验外科杂志,2015,32(6):1386.DOI:10.3760/cmad.issn.1001-9030.2015.06.062. Song QM,Fei C,Chen CM.Early warning of motor evoked potential for spinal cord injury induced by abdominal aorta occlusion in rabbits[J].Chin J Exp Surg,2015,32(6):1386.DOI:10.3760/cma.j.issn.1001-90302015.06.062.
相似文献/References:
[1]吴水华,陈朝晖,范双石,等.显微手术治疗2月龄婴儿颅内巨大动脉瘤1例并文献复习[J].临床小儿外科杂志,2020,19(06):523.[doi:10.3969/j.issn.1671-6353.2020.06.012]
Wu Shuihua,Chen Zhaohui,Fan Shuangshi,et al.Microsurgery of infantile intracranial aneurysm in a 2-month-old child with a literature review[J].Journal of Clinical Pediatric Surgery,2020,19(11):523.[doi:10.3969/j.issn.1671-6353.2020.06.012]
备注/Memo
收稿日期:2019-05-04。
基金项目:湖南省卫生健康委员会一般项目(编号:B2017118)
通讯作者:吴水华,Email:292454021@qq.com