椎管内肿瘤的诊断和手术治疗方式及其术后影响
Diagnosis and Surgical Treatment Methods of Intraspinal Tumors and Their Postoperative Impact
DOI: 10.12677/ACM.2023.1391957, PDF,   
作者: 胡入元:青海大学研究生院,青海 西宁;米明珊*:青海大学附属医院脊柱外科,青海 西宁
关键词: 椎管内肿瘤半椎板椎管成形全椎板Intraspinal Tumor Hemilaminectomy Laminoplasty Laminectomy
摘要: 椎管内肿瘤(Intraspinal tumors)是一种较为常见的中枢神经系统病变,目前手术切除肿瘤是治疗椎管内肿瘤的“金标准”,手术方法以传统的开放性椎板切除术为代表,但传统手术方式对脊椎稳定性破坏大,易引起术后脊柱不稳定等并发症,而且髓内肿瘤切除术导致一种或多种并发症的风险是髓外肿瘤的两倍,神经系统并发症的风险增加近四倍,从而形成了在此技术上改进来的椎板回植和半椎板切除术。三种术式都已被证明可以改善一般健康、生活质量、疼痛和生存率,但术后对患者影响仍然差异显著,本文对三种术式及对患者术后影响进行综述,为临床对椎管内肿瘤术式的选择提供参考。
Abstract: The intraspinal tumor is a kind of more common central nervous system lesions. At present, surgi-cal resection of tumors is the “gold standard” for the treatment of spinal canal tumors. The surgical methods are represented by traditional open laminectomy, but traditional surgical methods can greatly damage the stability of the spine and easily cause postoperative complications such as spi-nal instability. Moreover, the risk of one or more complications caused by intramedullary tumor resection is twice that of extramedullary tumors, and the risk of neurological complications in-creases by nearly four times. Thus, improved laminoplasty and hemilaminectomy were formed based on this technology. All three surgical methods have been proven to improve general health, quality of life, pain, and survival rate, but the postoperative impact on patients still varies signifi-cantly. This article reviews the three surgical methods and their postoperative impact on patients, providing reference for clinical selection of surgical methods for intraspinal tumors.
文章引用:胡入元, 米明珊. 椎管内肿瘤的诊断和手术治疗方式及其术后影响[J]. 临床医学进展, 2023, 13(9): 13999-14004. https://doi.org/10.12677/ACM.2023.1391957

参考文献

[1] Fisahn, C., Sanders, F.H., Moisi, M., et al. (2017) Descriptive Analysis of Unplanned Readmission and Reoperation Rates after Intradural Spinal Tumor Resection. Journal of Clinical Neuroscience, 38, 32-36. [Google Scholar] [CrossRef] [PubMed]
[2] 岳志丰, 纪树青. 胸腰椎脊髓外硬脊膜内肿瘤手术中的脊柱稳定性重建探讨[J]. 中国肿瘤临床与康复, 2013, 20(9): 1024-1026. [Google Scholar] [CrossRef
[3] Formo, M., Halvorsen, C.M., Dahlberg, D., et al. (2018) Minimally Invasive Microsurgical Resection of Primary, Intradural Spinal Tumors Is Feasible and Safe: A Consecutive Series of 83 Patients. Neurosurgery, 82, 365-371. [Google Scholar] [CrossRef] [PubMed]
[4] Jecko, V., Roblot, P., Mongardi, L., et al. (2022) Intramedullary Spi-nal Cord Lesions: A Single-Center Experience. Neurospine, 19, 108-117. [Google Scholar] [CrossRef] [PubMed]
[5] Weber, C., Gulati, S., Jakola, A.S., et al. (2014) Incidence Rates and Surgery of Primary Intraspinal Tumors in the Era of Modern Neuroimaging: A National Population-Based Study. Spine, 39, E967-E973. [Google Scholar] [CrossRef
[6] Ouma, J.R. (2019) Intradural Extramedullary Spinal Masses Treated at the Wits Teaching Hospitals between 2014-2017. South African Journal of Surgery, 57, 56-59.
[7] 马晓丽, 朴月善, 卢德宏, 等. Sox-10在神经鞘瘤和纤维型脑膜瘤鉴别诊断中的应用[J]. 诊断病理学杂志, 2012, 19(6): 457-460. [Google Scholar] [CrossRef
[8] 高明勇, 陶海鹰, 卫爱林, 等. 成人原发性椎管内肿瘤的外科治疗与疗效分析[J]. 中国肿瘤临床, 2017, 44(20): 1029-1033. [Google Scholar] [CrossRef
[9] Hersh, D.S., Iyer, R.R., Garzon-Muvdi, T., Liu, A., Jallo, G.I. and Groves, M.L. (2017) Instrumented Fusion for Spinal Deformity after Laminectomy or Laminoplasty for Resection of Intramedullary Spinal Cord Tumors in Pediatric Patients. Neurosurgical Focus, 43, E12. [Google Scholar] [CrossRef
[10] Dobran, M., Paracino, R., Nasi, D., et al. (2021) Laminectomy versus Unilateral Hemilaminectomy for the Removal of Intraspinal Schwannoma: Experience of a Single Institution and Review of Literature. Journal of Neurological Surgery, Part A: Central European Neurosurgery, 82, 552-555. [Google Scholar] [CrossRef] [PubMed]
[11] 叶勇强, 李洋, 刘欢, 郝建强, 谢飞, 夏永智, 廖正步, 晏怡. 经部分半椎板入路切除椎管内神经鞘瘤的疗效评价[J]. 临床外科杂志, 2021, 29(10): 933-936.
[12] 刘洪泉, 王立忠, 殷尚炯, 杜秀玉, 王洪生, 赵佩林, 王惠玲. 半椎板入路脊髓肿瘤切除后椎板再植26例临床分析[J]. 华北国防医药, 2009, 21(1): 28-29, 94.
[13] Shi, W., Wang, S., Zhang, H., et al. (2019) Risk Factor Analysis of Progressive Spinal Deformity after Resection of Intramedullary Spinal Cord Tumors in Patients Who Underwent Laminoplasty: A Report of 105 Consecutive Cases. Journal of Neurosurgery: Spine, 30, 655-663. [Google Scholar] [CrossRef
[14] 杨露露, 冯春国, 李志范, 程宏伟, 高鹏. 椎管重建在椎管内肿瘤术中的应用效果[J]. 安徽医学, 2017, 38(7): 898-901.
[15] Huang, M., Gao, X., Cheng, J., Han, J. and Liu, J. (2016) Laminoplasty versus Laminectomy and Fusion for Multilevel Cervical Compressive Myelopathy: A Me-ta-Analysis. Medicine, 95, e03588.
[16] 李玉伟, 王海蛟, 崔巍, 等. 保留棘上韧带连续性的椎板回植术在治疗腰椎管内良性肿瘤中的应用[J]. 中华神经医学杂志, 2022, 21(5): 469-473. [Google Scholar] [CrossRef
[17] Iacoangeli, M., Gladi, M., Di Rienzo, A., et al. (2012) Minimally Invasive Surgery for Benign Intradural Extramedullary Spinal Meningiomas: Experience of a Single Institution in a Cohort of Elderly Patients and Review of the Literature. Clinical Interventions in Aging, 7, 557-564. [Google Scholar] [CrossRef
[18] Wong, A.P., Lall, R.R., Dahdaleh, N.S., et al. (2015) Comparison of Open and Minimally Invasive Surgery for Intradural-Extramedullary Spine Tumors. Neurosurgical Focus, 39, E11. [Google Scholar] [CrossRef
[19] Lei, D., Zhou, Y., Yao, D., et al. (2021) Efficacy of Unilateral Hemilaminectomy for Intraspinal Tumor Resection: A Systematic Review and Meta-Analysis. Annals of Palliative Medi-cine, 10, 984-999. [Google Scholar] [CrossRef] [PubMed]
[20] 赵庆林, 步玮, 吴健, 等. 神经电生理监测在椎管内肿瘤患者术中应用的价值[J]. 中国脊柱脊髓杂志, 2012, 22(8): 682-684.
[21] 李宝龙, 李玉斌, 张海垠, 等. 脊髓肿瘤术后硬脊膜外瘢痕粘连的发生机制及预防方法[J]. 山东医药, 2015(5): 75-77. [Google Scholar] [CrossRef
[22] Naganawa, T., Miyamoto, K., Hosoe, H., Suzuki, N. and Shimizu, K. (2011) Hemilaminectomy for Removal of Extramedullary or Extradural Spinal Cord Tumors: Medium to Long-Term Clinical Outcomes. Yonsei Medical Journal, 52, 121-129. [Google Scholar] [CrossRef] [PubMed]
[23] Hao, X. and Lin, W. (2021) Vertebral Plate and Ligament Compo-site Laminoplasty in Spinal Cord Tumor Surgery: Analysis of 94 Patients. Translational Neuroscience, 12, 40-45. [Google Scholar] [CrossRef] [PubMed]
[24] 张东骜, 赵新岗, 梁聪, 王寅千, 吴锟, 王聖茜, 张帆, 盖起飞, 范涛. 椎板切除术与椎板复位术对颈椎髓内肿瘤患者术后颈椎畸形发生的影响[J]. 骨科临床与研究杂志, 2022, 7(3): 151-156. [Google Scholar] [CrossRef
[25] 张占阅, 张安龙, 梅小龙, 侯晓峰, 赵志军, 张春阳. 椎板成形术治疗椎管内肿瘤的临床应用研究[J]. 中国现代医生, 2020, 58(17): 8-10.