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目的探讨不同类型脊髓血管网织细胞瘤(简称脊髓血网)显微手术治疗的疗效及要点。方法收集我院2011年10月至2015年1月收治的脊髓血网患者23例,其中VHL病5例。采用McCormick标准评价患者术前、术后脊髓功能。根据肿瘤与脊髓的关系将脊髓血网分为3型:髓内型、髓外型及嵌入型,回顾性分析各型的影像学特点、手术方式及预后。结果 23例脊髓血网均在显微手术下全切,其中髓内型10例、髓外型9例、嵌入型4例。术后1周患者症状改善18例,其中髓外型脊髓血网改善8例、嵌入型4例、髓内型6例,无变化者2例,3例加重病例均为髓内型。各型脊髓血网术前、术后6月McCormick分级的组间差异均无统计学意义(P>0.05)。无手术死亡病例。随访期间无肿瘤原位复发。结论显微手术是治疗脊髓血网的有效方法,术后患者症状可改善明显,髓外型和嵌入型肿瘤疗效优于髓内型。
Objective To investigate the efficacy and main points of microsurgical treatment of different types of spinal hemangioblastomas (referred to as spinal cord blood network). Methods Twenty-three patients with spinal cord blood network were collected from October 2011 to January 2015 in our hospital, including 5 cases of VHL. The McCormick criteria were used to evaluate preoperative and postoperative spinal cord function. According to the relationship between tumor and spinal cord, the spinal cord blood network was divided into 3 types: intramedullary, extramedullary and embedded type. The imaging features, operation methods and prognosis of each type were retrospectively analyzed. Results All 23 cases of spinal cord blood were undergone microsurgical resection, including 10 cases of intramedullary, 9 cases of extramedullary and 4 cases of embedded. One week after operation, the symptoms were improved in 18 cases, including 8 cases of extramedullary spinal cord blood network improvement, 4 cases of embedded type, 6 cases of intramedullary type, 2 cases of no change, and 3 cases of aggravated cases were intramedullary type. There was no significant difference between the groups of McCormick grading before and 6 months after the operation (P> 0.05). No surgical deaths. No recurrence of tumor in situ during follow-up. Conclusion Microsurgery is an effective method for the treatment of spinal cord blood network. The symptoms of the patients can be obviously improved after operation. The efficacy of extramedullary and embedded tumors is better than intramedullary.