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目的探讨患者性别、年龄、临床病程、肿瘤部位与性质和手术切除程度等对多节段髓内良性肿瘤手术效果的影响。方法总结54例多节段(3个椎体节段以上)髓内良性肿瘤患者的临床资料,患者均行后正中入路显微镜下肿瘤切除术。将二便功能状态分为4级[正常、尿频和(或)便秘等轻度异常、排便困难等中度异常、失禁],以改良JOA(IJOA)评分系统评价神经功能状况,以IJOA分值差(术后和术前IJOA差值)评估手术效果。患者随访4～76个月。以Logistic回归和多元线性回归分析统计学数据。结果临床病程(χ2=10.37,P=0.02)和肿瘤长径(χ2=19.58,P=0.02)是术前二便功能的有效影响因素。二便功能(t=-4.62,P=0.000)直接影响术前神经功能状况(IJOA值)。肿瘤长径(χ2=11.23,P=0.02)有效影响手术效果(IJOA分值差),瘤径较短患者术后神经功能一过性恶化,但术后2年内一般都会不同程度的恢复。结论肿瘤瘤体较长或病程较长会恶化患者的二便功能,间接影响患者术前的神经功能状态。应争取早期诊治多节段髓内良性肿瘤,避免神经功能的进一步恶化。
Objective To investigate the effects of gender, age, clinical course, location and nature of the tumor, degree of resection and so on on the surgical outcomes of multi-segment intramedullary benign tumors. Methods The clinical data of 54 patients with benign intramedullary nodules with multiple segments (more than 3 vertebral segments) were summarized. The patients underwent posterior midline microsurgical tumor resection. The patients were divided into four grades according to their IJOA score (IJOA score system). The IJOA score was used to evaluate the neurological status. The IJOA scores were classified into 4 levels (mild, frequent urination and / or mild constipation, moderate abnormalities such as defecation, incontinence) Poor (postoperative and preoperative IJOA difference) to assess the surgical effect. Patients were followed up for 4 to 76 months. Logistic regression and multivariate linear regression analysis of statistical data. Results The clinical course (χ2 = 10.37, P = 0.02) and tumor length (χ2 = 19.58, P = 0.02) were the effective influencing factors for the preoperative diubermal function. The second function (t = -4.62, P = 0.000) directly affects the preoperative neurological status (IJOA). The long diameter of tumor (χ2 = 11.23, P = 0.02) effectively affected the surgical outcome (IJOA score difference). Patients with shorter diameter had a transient worsening of neurological function, but usually recovered to varying degrees within 2 years after operation. Conclusion Long tumor or longer course of disease will aggravate the second defecation function in patients with indirect impact on the patient’s preoperative neurological status. Should seek early diagnosis and treatment of multi-segment intramedullary benign tumor, to avoid further deterioration of neurological function.