Jiang W J, Wang Y Z, Yang J, Jia W Q
Department of Neurosurgery, Tian Tan Hospital of Capital Medical University, Beijing 100071, China.
Zhonghua Yi Xue Za Zhi. 2020 Feb 4;100(4):274-278. doi: 10.3760/cma.j.issn.0376-2491.2020.04.007.
To explore the application, advantages and disadvantages of minimally invasive surgery for lumbar schwannoma. this study was a prospective, non-randomized controlled study with a trial group (minimally invasive surgery group) and a control group (traditional laminectomy group).For the patients with lumbar schwannoma hospitalized in the neurosurgical spinal ward of Beijing Tian Tan hospital, the surgeon communicated with them one-on-one to inform the patients of the advantages and disadvantages of minimally invasive surgery through channels and traditional laminectomy. After the surgical risks and their respective advantages and disadvantages were identified, patients who underwent minimally invasive surgery to remove tumors through the channel were admitted to the channel surgery group according to the wishes of the patients; otherwise, patients who underwent traditional laminectomy were included in the control group. From December 2017 to March 2019, a total of 15 patients (experimental group) were treated with minimally invasive surgery. A total of 15 patients with tumors similar in size and location to those in the experimental group were selected from the control group who were hospitalized during the same period for traditional laminectomy. Relevant clinical data of the two groups of patients were collected and analyzed, including preoperative lesion imaging characteristics, intraoperative blood loss, operation time, postoperative hospital stay, postoperative complications, symptom improvement, etc. the operating time of the experimental group and the control group was (157±27) min and (158±29) min, respectively (0.897). Intraoperative blood loss was (66±27) ml and (110±43) ml, respectively (0.020). The mean hospital stay was (7.60±1.29) days and (11.67±1.23) days, respectively (0.000). Postoperative JOA scores were 26.73±2.84 and 26.60±2.41, respectively (0.891). Postoperative VAS scores were 0.40±1.12 and 0.27±0.71, respectively (0.699).The mean blood loss and hospital stay in the experimental group were significantly lower than those in the control group, the difference in operation time between the two groups was not significant, and there was no difference in neurological function results. In certain types of lumbar schwannoma tumors (non-giant tumors), minimally invasive resection through channels has the advantages of less surgical trauma, less bleeding, faster recovery and definite curative effect, which is a safe and effective surgical treatment.
为探讨微创治疗腰椎神经鞘瘤的应用情况、优缺点。本研究为前瞻性、非随机对照研究，分为试验组（微创手术组）和对照组（传统椎板切除术组）。对于在北京天坛医院神经外科脊柱病房住院的腰椎神经鞘瘤患者，手术医生与患者一对一沟通，通过椎间孔镜和传统椎板切除术两种方式，向患者告知微创手术和传统手术的优缺点。在明确手术风险及其各自的优缺点后，根据患者意愿，将通过椎间孔镜进行微创手术切除肿瘤的患者纳入椎间孔镜手术组；否则，将接受传统椎板切除术的患者纳入对照组。2017年12月至2019年3月，共有15例患者（试验组）接受了微创手术治疗。从同期住院行传统椎板切除术的对照组中选取15例肿瘤大小和位置与试验组相似的患者。收集并分析两组患者的相关临床资料，包括术前病变影像学特征、术中出血量、手术时间、术后住院时间、术后并发症、症状改善情况等。试验组和对照组的手术时间分别为（157±27）分钟和（158±29）分钟（P = 0.897）。术中出血量分别为（66±27）毫升和（110±43）毫升（P = 0.020）。平均住院时间分别为（7.60±1.29）天和（11.67±1.23）天（P = 0.000）。术后JOA评分分别为26.73±2.84和26.60±2.41（P = 0.891）。术后VAS评分分别为0.40±1.12和0.27±0.71（P = 0.699）。试验组的平均出血量和住院时间明显低于对照组，两组手术时间差异无统计学意义，神经功能结果无差异。对于某些类型的腰椎神经鞘瘤（非巨大肿瘤），通过椎间孔镜进行微创切除具有手术创伤小、出血少、恢复快、疗效确切等优点，是一种安全有效的手术治疗方法。
