摘要
目的:总结椎管内畸胎瘤的临床特点和治疗经验。方法:1997年8月～2008年5月,我院手术治疗椎管内畸胎瘤患者20例,男9例,女11例,年龄7～54岁,平均26.5岁。下肢麻木、疼痛12例,大小便功能障碍10例,双下肢无力6例。MRI检查显示肿瘤含有低、等、高混杂信号,多数无明显强化。肿瘤位于颈段1例,其余19例均位于胸腰段脊髓圆锥附近;肿瘤位于髓内5例,硬膜下-髓内外15例。均于显微镜下行肿瘤分离切除术,清除肿瘤囊内容物,切除囊壁和肿瘤的实性部分。结果:肿瘤全切除9例,次全切除11例。术后发生脑脊液漏2例,切口感染1例,泌尿系感染2例。术前12例肢体疼痛麻木患者术后10例症状缓解或消失,2例无变化;6例运动障碍者3例术后功能改善,2例无变化,1例加重;10例大小便功能障碍者6例改善,4例无变化。病理检查20例患者均为囊性成熟性畸胎瘤。随访3个月～10年,平均4.1年,脊髓功能状态按McCormick分级标准评价,好转15例,不变4例,恶化1例。随访期间未见肿瘤复发。结论:椎管内畸胎瘤多分布于脊髓圆锥区域,良性多见,以慢性脊髓及神经压迫症状为主要表现。在显微镜下尽量全切肿瘤的囊性部分可取得满意疗效。
Objective ：To investigate the diagnosis and treatment of teratoma of the spinal cord.Method：From August 1997 to May 2007,20 patients with intra-spinal teratomas who underwent surgical treatment were analyzed retrospectively.There were 9 males and 11 females with an average age of 26.5 years （range from 7-54 yeam）.The pain,numbness and bowel bladder dysfunction were the main symptoms.MRI revealed the tumors containing mixture signal,mostly including cystic and solid components,without apparent enhancement.19 cases located at the level of thoracic-lumbar spine, 1 case at cervical spine,respectively.There were 5 tumors located within the spinal cord,15 tumors in the subdural-extramedullary and intramedullary region.The surgical treatment involved eliminating of the content of the cystic component,then removal of the cystic wall under microscope,followed by removal of the solid element of the tumor.Result：Of 20 operations,total resection of the tumors was in 9 cases,and subtotal resection in 11 cases.Surgical complications included cerebrospinal fluid leakage in 2 patients,incision infection in 1 patient and bladder infection in 2 patients.In the 12 patients with pain or numbness symptoms prior the operation, 10 patients obtained symptoms relief while other 2 patients did not.Among the 6 patients with motor deficit,3 of them had been improved,2 patients had no change,and 1 patient became deteriorated,of 10 patients with sphincter dysfunction,6 patients were improved and 4 patients without any change.The histological examination showed all the 20 cases were mature cystic teratomas.The period of follow-up was ranged from 3 months to 10 years （with an average of 4.1 years）.Neurological status was evaluated by McCormick grading scale,it improved in 15 patients,unchanged in 4 patients,deteriorated in 1 patient.No recurrence happened.Conclusion：The intra-spinal teratomas are mainly located at the conus of spinal cord,most of tehem are benign.Their major clinical presentations are chronic pain and neurological deficits.Well-resection of the cystic component under the microscope is the key point for the surgery and the outcome of surgical treatment is satisfactory.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2009年第2期90-93,共4页
Chinese Journal of Spine and Spinal Cord
