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目的探讨肢体周围神经鞘瘤显微外科治疗的效果及手术技巧。方法 2003年5月至2010年6月,郑州市第二人民医院采用显微外科技术治疗肢体周围神经鞘瘤16例。手术采用常规神经探查切口,从两端正常组织处向肿瘤解剖,游离出神经干及肿块。之后,采用显微外科技术进行肿瘤的分离及取出,不切除肿瘤包膜,确保神经干的连续性,并尽可能减少损伤神经束间的交通支。结果本组16例均在确保神经干连续性的基础上将肿瘤的完整取出,经病理检查确诊。术后切口均Ⅰ期愈合。患者均获随访,时间26～39个月,平均32个月。末次随访时,13例感觉及运动正常;2例感觉功能恢复正常,运动功能部分恢复,肌力4级;1例尺神经鞘瘤9年,感觉功能大部分恢复,肌力3级,手内肌未见恢复。全部患者Tinel征(-),均未见复发。结论肢体周围神经鞘瘤,用一般外科方法切除,易损伤正常神经纤维,带来神经功能损害。应用显微外科技术,可把手术做得更为精细,减少或避神经损害的发生,从而提高手术疗效。
Objective To investigate the effect and surgical technique of microsurgical treatment of schwannoma around the limbs. Methods From May 2003 to June 2010, the Second People ’s Hospital of Zhengzhou City used microsurgical techniques to treat peripheral nerve sheath tumors in 16 cases. Surgery using conventional nerve exploration incision, from both ends of the normal tissue dissection to the tumor, freeing the nerve trunk and lumps. After the use of microsurgical techniques for tumor separation and removal, removal of the tumor capsule to ensure the continuity of nerve stem, and to minimize damage to the transport branch between the nerve bundle. Results The group of 16 patients were in complete continuity of the neural stem on the basis of the complete removal of the tumor confirmed by pathological examination. Postoperative incision healed first. All patients were followed up for 26-39 months with an average of 32 months. In the last follow-up, 13 patients had normal sensory and motor function, 2 patients had normal sensory function, partial recovery of motor function, and 4 muscular strength. One patient had ulnar nerve sheath tumor for 9 years, most of sensory function recovered, muscle strength was 3, No muscle recovery. All patients Tinel sign (-), no recurrence. Conclusion Peripheral schwannoma, with general surgical excision, easy to damage the normal nerve fibers, resulting in neurological damage. Application of microsurgery technology, surgery can be done more sophisticated, to reduce or avoid the occurrence of nerve damage, thereby enhancing the surgical effect.