[1]林国中 马长城** 吴超.显微镜下微通道锁孔技术切除脊髓腹侧肿瘤[J].中国微创外科杂志,2020,01(1):52-57.
　Lin Guozhong,Ma Changcheng,Wu Chao..Microscopic Resection of Ventral Intradural Spinal Cord Tumors Through Microchannel Keyhole Approach[J].Chinese Journal of Minimally Invasive Surgery,2020,01(1):52-57.
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显微镜下微通道锁孔技术切除脊髓腹侧肿瘤()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年1期
页码:
52-57
栏目:
短篇论著
出版日期:
2020-03-25

文章信息/Info

Title:
Microscopic Resection of Ventral Intradural Spinal Cord Tumors Through Microchannel Keyhole Approach
作者:
林国中 马长城** 吴超
（北京大学第三医院神经外科，北京100191）
Author(s):
Lin Guozhong;  Ma Changcheng;  Wu Chao.
Department of Neurosurgery, Peking University Third Hospital, Beijing 100191,China
关键词:
微通道; 神经内镜; 脊髓腹侧肿瘤; 椎管内肿瘤; 稳定性
Keywords:
Microchannel; Neuroendoscope; Ventral intadural spinal cordtumor; Intraspinal tumor; Stability
文献标志码:
A
摘要:
目的探讨微通道锁孔技术切除脊髓腹侧肿瘤的技术要点和应用价值。 方法回顾性分析2018年6月~2019年6月12例椎管内脊髓腹侧肿物的临床资料，肿瘤位于颈椎管5例，胸椎管7例，长径1~2 cm。应用电生理监测辅助，采用显微镜下微通道锁孔技术切除。结果肿瘤均获全切除，手术时间60~150 min，平均101.2 min。术后住院时间3~7 d，平均5.2 d。术后病理为肠源性囊肿4例，脊膜瘤5例，神经鞘瘤1例，蛛网膜囊肿1例，皮样囊肿1例。术后无感染、脑脊液漏，无神经功能障碍加重。术后随访3~15个月，中位数9个月，未见脊柱不稳定或畸形，未见肿瘤复发或残留。按McCormick分级，均为Ⅰ级。结论合理利用显微外科技术和辅助设备，2个节段以下的脊髓腹侧髓外肿瘤通过微通道锁孔技术可Ⅰ期全切。微通道技术有利于保持脊柱的完整性及稳定性。恰当选择适应证和应用电生理监测辅助是手术安全可靠的保证。
Abstract:
ObjectiveTo explore the technical points and application value of microchannel keyhole approach in resection of ventral intadural spinal cord tumors.MethodsThe clinical features, imaging characteristics and surgical methods of 12 cases of ventral intadural spinal cordtumor which were microscopically operated through microchannel keyhole approach from June 2018 to June 2019 were reviewed and analyzed. There were 5 tumors located in cervical region and 7 tumors in thoracic region. The length of tumors were 1-2 cm. Intraoperative electrophysiological monitoring was used in all operations.ResultsAll the tumors were totally resected. The operation time was 60-150 minutes, with an average of 101.2 minutes. The hospital stay was 3-7 days, with an average of 5.2 days. Postoperative pathology included 4 cases of enterogenous cyst, 5 cases of meningioma, 1 case of schwannoma, 1 case of arachnoid cyst and 1 case of dermoid cyst. No infection, cerebrospinal fluid leakage or neurological impairment was found after operation. The followup period ranged from 3 to 15 months (median, 9 months). No spinal instability or deformity was found, and no recurrence or residual tumors was noted. According to the McCormick classification, they were all grade Ⅰ.ConclusionsThe ventral intadural spinal cord tumors within two segments can be totally resected at one session with microchannel keyhole approach with assistance of auxiliary equipment. Microchannel keyhole approach is in favor of maintaining the integrity and stability of the spine. Appropriate selection of patients and application of electrophysiological monitoring are the guarantee of safety.

参考文献/References:

[1]林国中，王振宇，赵薇.电生理监测下显微手术切除胸段脊髓腹侧脊膜瘤. 中国临床神经外科杂志,2013,18(12):728-730.
[2]李凯，车万民，周杰，等.侧前方入路显微手术切除胸段脊髓腹侧肿瘤四例.中华神经外科杂志,2015,31(1):93-94.
[3]王曲，高方友，刘窗溪，等.高颈段脊髓腹侧神经管肠源性囊肿的显微外科治疗.中华神经外科杂志,2016,32(6):561-565.
[4]马长城，王振宇.半椎板切除入路治疗颈椎管哑铃型肿瘤.中国微创外科杂志,2001,1(6):336-337.
[5]林国中，王振宇，谢京城，等.半椎板入路显微手术治疗颈椎椎管内肿瘤.中国临床神经外科杂志,2010,15(7):390-392.
[6]吴超，王振宇，林国中，等.颈椎单侧半椎板及不同程度小关节切除术后生物力学变化的有限元分析.中华神经外科疾病研究杂志,2018,17(4):352-356.
[7]Mende K,Krtzig T,Mohme M,et al.Keyhole approaches to intradural pathologies.Neurosurg Focus,2017,43(2):E5.
[8]Reisch R,Koechlin N,Marcus H.Minimally invasive keyhole approaches in spinal intradural tumor surgery: report of two cases and conceptual considerations.J Neurosurg Sci,2016,60(3):392-397.
[9]林国中，马长城，吴超.显微镜下微通道锁孔技术在椎管肿物手术中的应用.中国微创外科杂志,2019,19(6):494-497.
[10]Turel MK,D’Souza WP,Rajshekhar V.Hemilaminectomy approach for intradural extramedullary spinal tumors: an analysis of 164 patients.Neurosurg Focus,2015,39(2):E9.
[11]Kaya RA.Surgical excition of spinal intradural meningiomas through a singlesided minimally invasive approach:keyhole laminotomy.Asian Spine J,2015,9(2):225-231.
[12]徐杰，余博飞，郑武，等.经皮穿刺斜置显微通道下keyhole手术切除胸椎管内脊膜瘤.中华医学杂志,2019,99(13):983-987.
[13]林国中，王振宇，刘斌.神经电生理监测技术在椎管内病变术中的应用.北京大学学报(医学版),2012,44(5):776-779.

备注/Memo

备注/Memo:
基金项目：首都临床特色应用研究项目（Z171100001017120）**通讯作者，Email：ma2001612@163.com
更新日期/Last Update: 2020-04-16