[1]林国中 张嘉 吴超 司雨 于涛 杨辰龙 谢京城** 杨军.显微切除联合硬膜囊末端松解拴系治疗成人椎管内畸胎瘤合并脊髓拴系综合征[J].中国微创外科杂志,2021,01(7):600-604.
　Lin Guozhong,Zhang Jia,Wu Chao,et al.Treatment of Adult Intraspinal Teratoma With Tethered Cord Syndrome by Microsurgical Excision of Tumor and Release of Tethered Cord at End of Dural Sac[J].Chinese Journal of Minimally Invasive Surgery,2021,01(7):600-604.
点击复制

显微切除联合硬膜囊末端松解拴系治疗成人椎管内畸胎瘤合并脊髓拴系综合征()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年7期
页码:
600-604
栏目:
临床研究
出版日期:
2021-07-25

文章信息/Info

Title:
Treatment of Adult Intraspinal Teratoma With Tethered Cord Syndrome by Microsurgical Excision of Tumor and Release of Tethered Cord at End of Dural Sac
作者:
林国中 张嘉 吴超 司雨 于涛 杨辰龙 谢京城** 杨军
（北京大学第三医院神经外科北京大学医学部精准神经外科与肿瘤研究中心，北京100191）
Author(s):
Lin Guozhong;  Zhang Jia;  Wu Chao;  et al.
Department of Neurosurgery, Peking University Third Hospital, Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Beijing 100191, China
关键词:
畸胎瘤; 脊髓拴系综合征; 椎管内肿瘤; 稳定性; 电生理监测
Keywords:
Teratoma; Tethered cord syndrome; Intraspinal tumor; Stability; Electrophysiological monitoring
文献标志码:
A
摘要:
目的探讨成人椎管内畸胎瘤合并脊髓拴系综合征的显微手术方法和效果。方法回顾性分析2010年9月~2020年12月31例成人椎管内畸胎瘤合并脊髓拴系综合征的临床资料。肿瘤长径1~3.8 cm，平均2.2 cm。临床症状包括腰背痛21例，下肢及鞍区感觉障碍（麻木）10例，下肢力弱14例，大小便功能障碍15例。采用显微手术切除肿瘤内膜和肿瘤实体，于硬膜囊末端切断终丝。结果肿瘤9例全切除，22例次全切除；肿瘤内膜27例全切除，4例次全切除。手术时间110~155 min，平均127 min。术后病理均为成熟囊性畸胎瘤。术后无感染，无死亡。新发神经功能障碍6例，包括节段性感觉减退3例（3个月恢复正常），排尿困难5例（6个月恢复正常）；其余25例无神经功能障碍加重。术后随访5~36个月，中位数24个月。1例内膜次全切除者术后1年畸胎瘤复发再次手术，其他30例未见复发，未见再拴系。疼痛视觉模拟评分（Visual Analogue Scale，VAS）显著降低，日本骨科协会(Japanese Orthopedic Association，JOA)评分和JOA括约肌功能评分显著升高（P<0.05）。结论椎管内畸胎瘤合并脊髓拴系综合征时，需要尽可能切除畸胎瘤内膜，降低复发概率，松解粘连并于硬膜囊末端切断终丝，缓解神经受压和牵拉症状。
Abstract:
ObjectiveTo explore the microsurgical method and effect for adult intraspinal teratoma with tethered cord syndrome.MethodsThe clinical features, imaging characteristics and surgical methods of 31 cases of intraspinal teratoma complicated with tethered cord syndrome from September 2010 to December 2020 which were microscopically operated were reviewed and analyzed. The length of the tumor ranged from 1 cm to 3.8 cm, with an average of 2.2 cm. The clinical symptoms included low back pain in 21 cases, sensory disturbance (numbness) of lower limbs and sellar area in 10 cases, lower limb weakness in 14 cases, and urination and defecation dysfunction in 15 cases. The intima and the solid portion of the tumor were resected by microsurgery. The filum terminale was cut at the end of dural sac.ResultsOf the 31 cases, the teratomas were totally resected in 9 cases and subtotally resected in 22 cases. The tumor intima were totally resected in 27 cases and partially resected in 4 cases. The operation time was 110-155 min, with an average of 127 min. The postoperative pathology was mature cystic teratomas in all the cases. There was no infection or death. Postoperatively, 3 patients had segmental hypoesthesia who returned to normal in 3 months, 5 patients had dysuria who returned to normal in 6 months, and the rest had no aggravation of neurological dysfunction. The followup period ranged from 5 to 36 months, with a median of 24 months. One case of teratoma with partial resection of tumor intima recurred one year after operation. No other recurrence or retethering was found. The Visual Analogue Scale (VAS) score decreased significantly, and the Japanese Orthopedic Association (JOA) score and JOA sphincter function score increased significantly (P<005).ConclusionsWhen intraspinal teratoma was complicated with tethered cord syndrome, it is necessary to remove the teratoma intima as much as possible to reduce the recurrence possibility. It is vital to release the adhesion and cut the terminal filament at the end of dural sac to completely relieve the symptoms of nerve compression and tethered cord.

参考文献/References:

[1]郜彩斌,孙涛,宋子木,等.成人椎管内畸胎瘤的诊断及治疗(附11例报告).中华神经外科杂志,2020,36(11):1121-1125.
[2]赵东升,王正君,孙刚锋,等.椎管内畸胎瘤的诊断与治疗.中国临床神经外科杂志,2015,20(11):661-664.
[3]蔡明,刘建民.脊髓栓系手术治疗新进展.中华神经外科疾病研究杂志,2017,16(1):90-91.
[4]谢京城,王振宇,刘彬,等.椎管内圆锥马尾区畸胎瘤的治疗.中国临床神经外科杂志,2018,23(7):455-457,462.
[5]谢京城，王振宇，陈晓东.骶管终丝脊膜囊肿合并脊髓拴系综合征的诊断和治疗.中国临床神经外科杂志,2015,20(11):651-653,657.
[6]Hukuda S,Mochizuki T,Ogata M,et al.Operations for cervical spondylotic myelopathy.A comparison of the results of anterior and posterior procedures.J Bone Joint Surg Br,1985,67(4):609-615.
[7]Kirollos RW,Van Hille PT.Evaluation of surgery for the tethered cord syndrome using a new grading system.Br J Neurosurg,1996,10(3):253-260.
[8]谢京城,王振宇,马长城,等.660例椎管肿瘤的手术治疗.中国微创外科杂志,2009,9(10):940-945.
[9]Selcuki M,Mete M,Barutcuoglu M,et al.Tethered cord syndrome in adults:experience of 56 patients.Turk Neurosurg,2015,25(6):922-929.
[10]雷晓雯,程敬亮,冉云彩.椎管内畸胎瘤的MRI及临床表现.实用放射学杂志,2020,36(4):529-532.
[11]贾坤,余建群,刘莹.椎管内畸胎瘤MRI表现.中国介入影像与治疗学,2020,17(8):508-510.
[12]林国中,马长城,王振宇,等.超声骨刀椎板成形椎板植骨在椎管肿瘤手术中的应用.中国微创外科杂志,2018,18(2):101-103,109.

备注/Memo

备注/Memo:
基金项目：国家自然科学基金（81601200）；首都临床特色应用研究项目（Z171100001017120）；北京大学临床医学+X专项项目（PKU2020LCXQ004）**通讯作者，Email：ab1965@163.com
更新日期/Last Update: 2021-10-11