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目的:探讨经半椎板切除入路行椎管内硬膜下肿瘤切除术的可行性及疗效。方法:1996年8月～2007年4月共手术治疗106例颈、胸、腰椎管内硬膜下肿瘤患者,其中神经源性肿瘤103例,脂肪瘤2例,畸胎瘤1例,MRI显示肿瘤大小为11×14mm～15×32mm。均在偏肿瘤侧对应肿瘤节段切除半侧椎板、棘突根部、关节突内1/3,切开硬膜,游离并切除肿瘤。随访观察治疗效果。结果:106例肿瘤均获得顺利切除,手术时间45～70min,平均54min;出血量80～120ml,平均90ml。3例患者术后出现脑脊液漏,每日切口旁局部穿刺抽出漏出液,并采取头低脚高位,术后3周愈合。1例脂肪瘤患者术后当天出现尿潴留,给予留置尿管,应用皮质类固醇激素、神经营养药物,术后1个月完全恢复正常。81例获得4个月～11年1个月(平均3年5个月)随访,无颈、胸、腰痛等症状,获得随访的42例术前不完全性瘫痪患者肌力由术前3～4级恢复至术后5级。结论:位于椎管内脊髓背侧、腹侧及突入椎间孔的硬膜下肿瘤,采用半椎板切除入路可顺利切肿瘤组织,该方法出血少,创伤小,可最大限度地保护脊柱的稳定性。
Objective: To investigate the feasibility and efficacy of subdural excision of the subdural tumor by semi-laminectomy. Methods: From August 1996 to April 2007, 106 cases of subdural tumors in the neck, thoracic and lumbar spinal were treated surgically. There were 103 cases of neurogenic tumors, 2 cases of lipomas and 1 case of teratoma. MRI showed tumor Size is 11 × 14mm ~ 15 × 32mm. In the side of the tumor corresponding tumor segmental resection of the lamina, spinous process root, the articular process within 1/3, cut the dura, free and remove the tumor. Follow-up observation of the therapeutic effect. Results: All of the 106 tumors were successfully resected. The operation time ranged from 45 to 70 minutes, with an average of 54 minutes. The bleeding volume was 80 to 120 ml with an average of 90 ml. Three patients had cerebrospinal fluid leakage after surgery. Local leakage was obtained by puncture of the incision next to the incision and the head of the patient was lowered to a high position for 3 weeks after operation. One patient with lipoma showed urinary retention on the day after surgery, giving indwelling catheter, applying corticosteroid and neurotrophic drugs, and returned to normal one month after operation. Eighty-one patients were followed up for 4 months to 11 years and 1 month (average 3 years and 5 months) without neck, chest, lumbago and other symptoms. Forty-two patients with incomplete preoperative paralysis were followed up for 3 ~ 4 to 5 postoperative recovery. Conclusion: Subdural tumors located in the dorsal, ventral and intervertebral foramen of the spinal canal can be successfully resected by semi-laminectomy. This method has less bleeding and less trauma and can protect the spine to the maximum extent Stability.