Bai Shao Cong, Tao Ben Zhang, Wang Le Kai, Yu Xin Guang, Xu Bai Nan, Shang Ai Jia
Department of Neurosurgery, PLA General Hospital, Haidian District, Beijing, China.
Department of Neurosurgery, PLA General Hospital, Haidian District, Beijing, China.
World Neurosurg. 2018 Apr;112:e331-e341. doi: 10.1016/j.wneu.2018.01.044. Epub 2018 Jan 11.
The authors reviewed the treatment of adult patients with congenital intraspinal lipomas with total/near-total resection and discussed their preoperative characteristics, prognostic factors, and surgical outcomes.
Medical records of 122 adult patients with congenital lumbosacral lipomas undergoing total/near-total resection were systematically analyzed. The cohort was subdivided into 3 groups depending on symptom onset age: group 1 (≤5 years, n = 40), group 2 (>5 years but <18 years, n = 33), and group 3 (>18 years, n = 49). Preoperative and postoperative neurologic status were compared between groups and analyzed as a whole.
The most common symptom was bladder dysfunction (82.0%), followed by constipation (76.2%). At the 3-month follow-up, improvement was noted in most patients presenting with pain (87.2%) and neuropathic ulcers (70.0%). Overall, neurologic status was improved in 73.0% of patients and stabilized in 19.7% of patients. A binary logistic regression model identified shorter preoperative duration (P = 0.013) and preoperative pain (P = 0.005) as independent predictors of postoperative improvement. Neurosurgical complications developed in 16 patients, and wound complications occurred in 2 patients. Two of 3 patients who had recurred symptoms underwent repeated detethering surgery during long-term follow-up.
Despite longer preoperative duration than the pediatric population, adult patients with lumbosacral lipomas can still benefit from total/near-total resection especially regarding pain and foot ulcers, with low surgery-related morbidity. The long-term advantage of resecting additional lipoma in adults remains a point of discussion.
作者回顾了对先天性脊髓内脂肪瘤成年患者进行全切除/近全切除的治疗情况，并讨论了他们的术前特征、预后因素和手术结果。
系统分析了122例接受全切除/近全切除的先天性腰骶部脂肪瘤成年患者的病历。根据症状出现年龄将该队列分为3组：第1组（≤5岁，n = 40），第2组（>5岁但<18岁，n = 33），第3组（>18岁，n = 49）。比较各组术前和术后的神经功能状态，并进行整体分析。
最常见的症状是膀胱功能障碍（82.0%），其次是便秘（76.2%）。在3个月的随访中，大多数出现疼痛（87.2%）和神经性溃疡（70.0%）的患者病情有所改善。总体而言，73.0%的患者神经功能状态得到改善，19.7%的患者病情稳定。二元逻辑回归模型确定术前病程较短（P = 0.013）和术前疼痛（P = 0.005）是术后改善的独立预测因素。16例患者发生神经外科并发症，2例患者出现伤口并发症。3例复发症状的患者中有2例在长期随访期间接受了再次松解手术。
尽管成年腰骶部脂肪瘤患者的术前病程比儿童患者长，但他们仍可从全切除/近全切除中获益，尤其是在疼痛和足部溃疡方面，且手术相关发病率较低。在成人中切除额外脂肪瘤的长期优势仍是一个讨论点。
