摘要
目的:探讨症状性骶管内蛛网膜囊肿的诊断与治疗方法。方法:对12例以骶管内神经受压表现为主,如腰骶部疼痛、下肢痛、会阴部疼痛,鞍区麻木不适,大小便障碍,下肢无力患者,行MRI检查。结合临床症状、体征及MRI表现明确诊断为症状性骶管内囊肿后行手术治疗。手术均在显微镜下操作。对未见明显交通孔的7例中5例行囊壁大部切除后残存囊壁修补缝扎,2例因硬脊膜缺如,无法修补而行囊肿部分切除旷置;5例有交通孔的患者中,2例囊肿大部切除后用肌肉填塞交通孔,2例因交通孔处理困难未作特殊处理,1例囊肿大部切除后,切开交通孔处硬脊膜以扩大交通孔至脑脊液通畅流出,消除交通孔的单向阀门作用。严密缝合切口,术后采取头低臀高俯卧位。结果:骶管内囊肿在MRI上表现为骶管内单发或多发类圆形或椭圆形的软组织影,呈长T1、长T2表现,信号与脑脊液相同。术后2例出现少量皮下积液,加压包扎2￣3个月后自行吸收,无1例脑脊液漏。随访3个月￣4年6个月,平均18.3个月,症状完全缓解8例,部分缓解3例,1例3个月后症状复发,MRI检查示囊肿较术前轻微扩大,未再次手术。结论:MRI检查是正确诊断骶管内蛛网膜囊肿的有力手段,伴有临床症状、体征者应考虑手术治疗。对囊肿的处理以囊肿大部切除为主,严密缝合切口各层及术后合理体位可以有效防止并发症的发生。
Objective：To evaluate the diagnosis and the treatment of the arachnoid cysts in the sacral canal. Method：12 patients with symptomatic sacral arachnoid cysts were included,their clinical symptoms resulted from compression of sacral nerve：included lumbosacral area pain or leg pain,pain or hypesthesia in the perineal region,bowl or urinary functional disturbance,weakened muscle power in the legs.MRI examination showed one or more round or elliptic soft tissue masses which displayed high T1 and T2 signals and the signal density was the same as that of cerebrospinal fluid.According to symptoms,physical test signs and MRI examination,symptomatic sacral arachnoid cysts could be diagnosised.After decompression of the sacral canal, arachnoid cysts were resected in five ways under microscope：5 cases of 7 without communication hole underwent the excision of the most of the cyst wall and suturing of redundant wall;2 cases of 7 underwent the excision of the most of the cyst wall and leaving them unsutured.2 cases of 5 with communication hole underwent the excision of the most of the cyst wall and plugging the communication hole with a block of muscle;2 cases underwent the excision of the most of the cyst wall without dealing with communication hole because of their difficulty; 1 case underwent the excision of the most of the cyst wall and enlarging the communication hole.All cases were follow-up for an average of 18.3 months （3-54 months ） .The radiological changes including X-ray,CT,MRI as well as their clinical behaviors,post-operative complications were evaluated.Result：The clinical symptoms relieved completely in 8 cases and relieved partially in 3 cases,1 case recurred.The complications included hydtocele and cerebrospinal fluid leakage.2 cases of 12 suffered small amounts hypodermal which was absorbed after 2-3 months by pressure dressing.There was no cerebrospinal fluid leakage.MRI of recurred patient showed that the cysts was bigger than that of pre-operation.Condusion： MRI is the most powerful method to identify the arachnoid cysts of sacral canal.Candidates for surgical intervention should take into consideration of both the clinical and imaging findings.The most of the cyst wall should be dissected by a microsurgical procedure.Every soft tissue should be closely sutured to prevent postoperative complications.A supine position should not be allowed so as to reduce the complication.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2006年第2期138-141,共4页
Chinese Journal of Spine and Spinal Cord
