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目的:总结椎管内畸胎瘤的临床特点和治疗经验。方法:1997年8月～2008年5月,我院手术治疗椎管内畸胎瘤患者20例,男9例,女11例,年龄7～54岁,平均26.5岁。下肢麻木、疼痛12例,大小便功能障碍10例,双下肢无力6例。MRI检查显示肿瘤含有低、等、高混杂信号,多数无明显强化。肿瘤位于颈段1例,其余19例均位于胸腰段脊髓圆锥附近;肿瘤位于髓内5例,硬膜下-髓内外15例。均于显微镜下行肿瘤分离切除术,清除肿瘤囊内容物,切除囊壁和肿瘤的实性部分。结果:肿瘤全切除9例,次全切除11例。术后发生脑脊液漏2例,切口感染1例,泌尿系感染2例。术前12例肢体疼痛麻木患者术后10例症状缓解或消失,2例无变化;6例运动障碍者3例术后功能改善,2例无变化,1例加重;10例大小便功能障碍者6例改善,4例无变化。病理检查20例患者均为囊性成熟性畸胎瘤。随访3个月～10年,平均4.1年,脊髓功能状态按McCormick分级标准评价,好转15例,不变4例,恶化1例。随访期间未见肿瘤复发。结论:椎管内畸胎瘤多分布于脊髓圆锥区域,良性多见,以慢性脊髓及神经压迫症状为主要表现。在显微镜下尽量全切肿瘤的囊性部分可取得满意疗效。
Objective: To summarize the clinical characteristics and treatment experience of intraspinal teratoma. Methods: From August 1997 to May 2008, 20 cases of intraspinal teratoma were treated by surgery in our hospital. There were 9 males and 11 females, aged from 7 to 54 years (average 26.5 years). Lower limb numbness, pain in 12 cases, toilet dysfunction in 10 cases, weakness in 6 cases. MRI examination showed that the tumor contains low, high, mixed signals, most without significant enhancement. The tumor was located in the cervical region in 1 case, the remaining 19 cases were located in the vicinity of the thoracolumbar spinal conus; tumor located in the intramedullary 5 cases, subdural - intramedullary and 15 cases. Under the microscope tumor resection resection, removal of tumor capsule content, removal of the solid wall and the solid part of the tumor. Results: Total resection in 9 cases, subtotal resection in 11 cases. Postoperative cerebrospinal fluid leakage in 2 cases, incision infection in 1 case, urinary tract infection in 2 cases. Preoperative 12 patients with limb pain and numbness in 10 cases of postoperative symptoms alleviate or disappear, 2 cases no change; 6 cases of movement disorders in 3 patients with functional improvement, 2 cases without change, 1 case aggravating; 10 cases of urinary incontinence 6 cases improved, 4 cases no change. Pathological examination of 20 patients were cystic maturity teratoma. The follow-up ranged from 3 months to 10 years, with an average of 4.1 years. The functional status of spinal cord was evaluated according to the McCormick classification criteria. Fifteen cases were improved, four cases unchanged and one case deteriorated. No tumor recurrence during follow-up. Conclusions: The intraspinal teratoma is mostly distributed in the conus of the spinal cord. It is benign and common, with chronic spinal cord and nerve compression symptoms as the main manifestation. Try to cut the cystic part of the tumor under the microscope to obtain satisfactory results.