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目的探讨椎管内肿瘤的显微外科治疗术式与方法选择,脊柱脊髓与神经功能的保护和重建,评价半椎板切除入路的优缺点。方法回顾性分析2004年1月至2007年7月经半椎板或全椎板手术切除椎管内肿瘤及对沟通性肿瘤部分采用附加切口手术共56例。椎管内外沟通性肿瘤8例;1例颈部与1例胸部沟通性肿瘤未切除椎板,余下均行椎板切除。结果手术后病理为:神经鞘瘤28例,脊膜瘤18例,神经节细胞瘤4例,星形细胞瘤4例,室管膜瘤2例;除星形细胞瘤2例外未能全切,其余均全切。半椎板切除入路者无手术并发症和脊柱畸形,术后下床早。结论经半椎板切除入路较全椎板入路显微外科手术切除椎管内肿瘤,能够尽可能减少对椎体损伤,保留脊柱后柱结构,组织的完整性;增强脊柱稳定性及减少脊柱功能损伤;患者术后效果好,卧床时间短;对椎管内外沟通性肿瘤根据具体情况选择合适的入路方法,同样可取得较好疗效。
Objective To investigate the microsurgical treatment of spinal canal tumor surgery methods and methods of choice, spinal cord and nerve function protection and reconstruction, evaluation of the advantages and disadvantages of half-laminectomy approach. Methods Retrospective analysis of January 2004 to July 2007 by laminectomy or total laminoplasty resection of the spinal canal tumor and communicating tumor part of the additional incision operation a total of 56 cases. 8 cases of intracranial and external communicating tumors, 1 case of cervical and 1 case of thoracic communicating tumors without laminectomy, and the remaining underwent laminectomy. Results The pathological changes were: schwannoma in 28 cases, meningioma in 18 cases, gangliocytoma in 4 cases, astrocytoma in 4 cases, ependymomas in 2 cases, except astrocytomas , The rest are all cut. Half of the laminectomy approach without complications and spinal deformities, early after bed. Conclusions The resection of the tumor in the spinal canal by microsurgical resection of the full laminectomy via the hemi-laminectomy can reduce the damage to the vertebral body and preserve the posterior column structure and the integrity of the spine. It can also enhance the stability and reduce the spinal stability Spinal dysfunction; patients with good effect, bed time is short; on the internal and external spinal canal tumors according to the specific circumstances to choose the appropriate approach, the same can be achieved better efficacy.