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目的通过对小儿腰骶部脊膜膨出手术方式的回顾性分析,探讨小儿腰骶部脊膜膨出手术方式与最佳疗效的相关性。方法对濮阳市人民医院自1997—2005收治的211例腰骶部脊膜膨出患儿进行分析,对1997年以前行单纯脊膜膨出切除修补术和1997年以后的脊膜膨出切除+椎管扩大神经松解+脊膜修补术两种手术方式进行对比,对伴有大小便控制不良和(或)下肢弛缓性瘫痪等神经症状者进行评估。结果单纯脊膜膨出切除修补术患儿术后原有神经症状未见明显改善或有部分加重。部分患儿术后再发脊髓栓系综合征(TCS)。部分患儿因年龄较小术后并发脑积水或死亡而失访。脊膜膨出切除+椎管扩大神经松解+脊膜修补术术后患儿未见再发TCS,但MRI示有椎管内神经粘连。部分患儿原有大小便失禁或下肢弛缓性瘫痪等神经症状较术前有明显改善或未再加重。结论单纯脊膜膨出切除修补术是患儿再发TCS的重要原因,脊膜膨出切除+椎管扩大神经松解+脊膜修补术是治疗小儿腰骶部脊膜膨出的较理想手术方式。
Objective To retrospectively analyze the operation mode of lumbosacral meningocele in children to explore the correlation between the lumbosacral meningocele and the best curative effect. Methods A total of 211 patients with lumbosacral meningocele who had been treated in Puyang People’s Hospital from 1997 to 2005 were analyzed. All patients underwent resection and repair of meningocele after 1997 and meningocele after 1997 Spinal expansion of neurolysis + meningitis repair two surgical methods were compared with those with bad urine control and / or flaccid paraplegia and other neurological symptoms were evaluated. Results Membranous resection of meningomyelia in children with postoperative neurological symptoms no significant improvement or partial worsening. Some children with recurrent tethered cord syndrome (TCS). Some children were lost to follow-up due to hydrocephalus or death after surgery. Spinal prolapse resection plus spinal canal enlargement of nerve release + meningitis repair no recurrence of children with TCS, but MRI showed intracranial nerve adhesion. Some children had incontinence or lower extremity flaccid paralysis and other neurological symptoms than the preoperative significantly improved or not worsened. Conclusions Simple medulum resection and repair is an important cause of recurrence of TCS in children. Mesenteric enlargement, lumbar enlargement, neuromodulation and spinal meningoplasty are the ideal surgical treatment for lumbosacral meningocele the way.