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目的分析总结小儿颈髓腹侧神经管原肠囊肿的临床特点、显微外科手术方法及治疗效果。方法回顾分析2011年1月至2016年1月采用颈后正中入路囊肿分层切除法显微外科治疗的小儿颈髓腹侧神经管原肠囊肿16例患者的临床资料,总结其临床表现、MRI特点和手术疗效。结果患儿肢体肌力在短期内(1~3天)进行性下降者5例。MRI特点分为有典型性和非典型性两种表现,典型表现者11例,非典型表现者5例。全部病例行颈后正中入路将囊肿分为两部分切除,病理结果均为神经管原肠囊肿,所有病例术后神经功能恢复良好。15例为单纯的神经管原肠囊肿未合并其他畸形,采用颈后入路将囊肿分两部分切除均获近全切除;1例为肠源性囊肿、脊髓脊膜膨出、椎体发育畸形及脊髓内畸胎瘤的复杂畸形,行脊髓脊膜膨出切除术同时行软性神经内镜切除囊肿术后半年复发,再次行后正中入路近全切除囊肿。随访8~38个月(平均30.2个月)无复发,症状完全消失14例,症状改善2例。结论颈髓腹侧神经管原肠囊肿其病情发展迅速,熟识其临床表现和MRI特点,尽早诊断及手术,合理评估手术难度至关重要,采用颈后正中入路囊肿分两部分切除囊肿可提高囊壁切除程度获得良好预后。
Objective To analyze and summarize the clinical features, microsurgical methods and therapeutic effects of neural tube gastrectomy in children with cervical spinal cord. Methods From January 2011 to January 2016, we retrospectively analyzed the clinical data of 16 patients with cervical spinal cord ventral neural tube gastrectomy treated with microsurgical stratified excision of posterior median cervical approach. MRI features and surgical efficacy. Results Children with limb muscle strength in the short term (1 to 3 days) were decreased in 5 cases. MRI features are divided into two types of typical and atypical manifestations, typical performance in 11 cases, 5 cases of atypical manifestations. All patients underwent posterior approach to the middle of the cysts were divided into two parts resection, pathological findings were neural tube cyst, all cases of neurological function recovered well. 15 cases of pure neural tube gastrectomy without other deformities, the use of posterior approach to the cyst in two parts were removed resection were nearly total resection; 1 case of gut-derived cysts, spinal meningitis, vertebral body deformity And intramedullary teratoma complex deformity, line myelomeningotomy resection at the same time soft endoscopic cyst resection six months after relapse, again after the line near the total resection cyst. All cases were followed up for 8 to 38 months (average 30.2 months) without recurrence. The symptoms disappeared completely in 14 cases and the symptoms improved in 2 cases. Conclusion Cervical spinal ventral neural tube gastrectomy is characterized by rapid development of the disease, familiar with its clinical manifestations and MRI features, early diagnosis and surgery, a reasonable assessment of the difficulty of surgery is essential, the use of the posterior cervical approach cysts divided into two parts can be improved cyst The degree of cyst wall resection achieved a good prognosis.