脊髓髓内海绵状血管瘤患者不同治疗方式的预后

doi:10.19723/j.issn.1671-167X.2023.04.014

摘要/Abstract

摘要：

目的: 探讨采取不同治疗方式的脊髓髓内海绵状血管瘤患者末次随访时的脊髓功能改善情况。方法: 回顾性研究2007年1月至2018年12月就诊于北京大学第三医院的30例脊髓髓内海绵状血管瘤患者，总结脊髓髓内海绵状血管瘤患者的性别、年龄、临床症状、影像学表现，采用欧洲脊髓病评分(European myelopathy score, EMS)评估患者治疗前后脊髓功能状态，分析手术治疗及保守治疗患者的预后。结果: 30例患者中，男性患者14例，女性患者16例(1 ∶ 1.14)，患者平均年龄为(48.1±13.6)岁(18~81岁)。单纯感觉障碍者3例，单纯肌力下降者2例，单纯疼痛者1例，肌力下降伴疼痛者1例，感觉障碍伴有肌力下降者5例，感觉障碍、肌力下降、二便异常者3例，感觉障碍、肌力下降、疼痛者3例，感觉障碍伴疼痛者8例，感觉障碍、疼痛、二便异常者1例，感觉障碍、疼痛、肌力下降、二便异常者1例，无症状者2例。共有11例患者病变位于颈椎区域，2例患者病变位于颈胸交界处，15例患者病变位于胸椎区域，2例患者病变位于腰椎区域。血管瘤最大径平均为(10.90±4.87) mm, 磁共振成像表现常为T2WI混杂信号及高信号，T1WI等信号或混杂信号。随访时间为(27.4±8.7)个月，包括手术治疗患者19例及保守治疗患者11例。手术治疗患者末次随访时脊髓功能较初次就诊时得到明显改善，差异具有统计学意义(P < 0.05)，保守治疗患者1例患者症状改善，2例患者症状加重，余患者保持平稳，治疗前后脊髓功能无明显改变，差异无统计学意义(P>0.05)。结论: 脊髓髓内海绵状血管瘤手术治疗效果确切，预后较好；保守治疗总体改善率较低，并且有加重风险。

关键词: 脊髓髓内海绵状血管瘤, 手术治疗, 保守治疗, 欧洲脊髓病评分

Abstract:

Objective: To investigate the improvement of spinal cord function in patients with spinal intramedullary cavernous hemangioma (SICH) treated with different methods at the last follow-up. Methods: A retrospective study of 30 patients with SICH in Peking University Third Hospital from January 2007 to December 2018 was conducted. Clinical data of 30 patients were collected including gender, age, clinical symptoms, and imaging manifestations were acquired from their clinical records. Spinal functions of the patients with SICH were evaluated by European myelopathy score (EMS). The functional status of the spinal cord before and after the last follow-up were analyzed. Results: Among the 30 patients, there were 14 male patients and 16 female patients (1 ∶ 1.14). The average age of the patients was (48.1±13.6) years (18-81 years). In the study, 3 cases were sensory disturbance; 2 cases manifested with only decreased muscle strength; 1 case showed simple pain; 1 case manifested with decreased muscle strength and pain; Sensory disturbance accompanied by decreased muscle strength occurred in 5 cases; 3 cases suffered from both sensory disturbance, decreased muscle strength and abnormal defecation; 3 cases suffered from sensory disturbance, decreased muscle strength and pain; 8 cases showed sensory disturbance and pain; 1 case had sensory disturbance, pain and abnormal defecation; 1 case had sensory disturbance, pain, decreased muscle strength and abnormal defecation; 2 cases were asymptomatic. There were 11 patients whose lesions were located in the cervical region, 2 patients located at the cervical-thoracic region, 15 patients located in the thoracic region, and 2 patients located in the lumbar spine. The average maximum diameter of hemangioma was (10.90±4.87) mm. Their magnetic resonance imaging (MRI) features were usually mixed signal and high signal on T2WI, and equal signal or mixed signal on T1WI. A total of 30 patients were followed up for (27.4±8.7) months, including 19 patients with surgical treatment and 11 patients with conservative treatment. The spinal cord function at the last follow up in surgical group was significantly improved. The difference was statistically significant (P < 0.05). Only one patient' s symptom in conservative treatment group improved. However, the symptoms of the two patients aggravated. Other patients remained stable. There was no significant difference in spinal cord function before and after treatment (P>0.05). Conclusion: The surgical treatment of SICH has obvious positive effect and good prognosis. The overall improvement rate of conservative treatment is relatively low with a risk of aggravation.

Key words: Spinal intramedullary cavernous hemangioma, Surgical treatment, Conservative treatment, European myelopathy score

中图分类号:

R651.2

陈斌,吴超,刘彬,于涛,王振宇. 脊髓髓内海绵状血管瘤患者不同治疗方式的预后[J]. 北京大学学报（医学版）, 2023, 55(4): 652-657.

Bin CHEN,Chao WU,Bin LIU,Tao YU,Zhen-yu WANG. Prognosis of patients with spinal intramedullary cavernous hemangioma by different treatments[J]. Journal of Peking University (Health Sciences), 2023, 55(4): 652-657.

图/表 6

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表1

脊髓髓内海绵状血管瘤患者的一般情况"

No.	Gender	Age/years	Clinical presentation	Chronic/acute	Location	Diameter/mm	Treatment	Improved/not improved
1	Male	50	Downregulated strength of muscle, pain	Chronic	T7	7	Surgery	Improved
2	Male	51	Sensory disorder, pain	Chronic	C7-T1	13	Surgery	Not Improved
3	Female	32	Sensory disorder, pain	Chronic	L5	9	Surgery	Not Improved
4	Female	45	Sensory disorder, pain	Chronic	C6-7	13	Surgery	Improved
5	Male	79	Downregulated strength of muscle	Chronic	T6-7	15	Surgery	Not Improved
6	Female	30	Sensory disorder, pain, downregulated strength of muscle	Chronic	C2	7	Surgery	Improved
7	Male	40	Sensory disorder, downregulated strength of muscle, defecation dysfunction	Chronic	T3	5	Surgery	Improved
8	Male	46	Sensory disorder, pain, defecation dysfunction	Chronic	T11	8	Surgery	Improved
9	Male	65	Sensory disorder, pain, downregulated strength of muscle, defecation dysfunction	Acute	C3	7	Surgery	Improved
10	Male	37	Sensory disorder, pain, downregulated strength of muscle, defecation dysfunction	Acute	T9-10	12	Surgery	Improved
11	Female	40	Sensory disorder, pain	Chronic	C6-T1	28	Surgery	Not Improved
12	Female	55	Sensory disorder, pain	Chronic	C2	6	Surgery	Improved
13	Female	49	Sensory disorder, pain, downregulated strength of muscle, defecation dysfunction	Acute	T9	9	Surgery	Improved
14	Male	34	Sensory disorder, pain, downregulated strength of muscle,	Chronic	T3	7	Surgery	Improved
15	Female	55	Sensory disorder, downregulated strength of muscle	Chronic	T8-9	11	Surgery	Improved
16	Female	72	Sensory disorder	Chronic	T2-3	15	Surgery	Not Improved
17	Male	81	Sensory disorder, downregulated strength of muscle	Chronic	T2-3	17	Surgery	Improved
18	Male	52	Sensory disorder, downregulated strength of muscle, defecation dysfunction	Chronic	T4	8	Surgery	Improved
19	Female	18	Sensory disorder, pain, downregulated strength of muscle, defecation dysfunction	Acute	T4	7	Surgery	Improved
20	Male	36	Sensory disorder, pain, downregulated strength of muscle, defecation dysfunction	Acute	T8-9	12	Conservative	Not Improved
21	Female	50	Pain	Chronic	C5-6	13	Conservative	Not Improved
22	Female	43	Sensory disorder, downregulated strength of muscle	Chronic	C6-7	11	Conservative	Not Improved
23	Female	31	Sensory disorder, pain	Chronic	C7	7	Conservative	Not Improved
24	Female	48	Sensory disorder, pain	Chronic	L2	6	Conservative	Not Improved
25	Male	31	Sensory disorder	Chronic	T1-3	24	Conservative	Not Improved
26	Female	61	Downregulated strength of muscle	Chronic	C2-4	23	Conservative	Not Improved
27	Male	58	Sensory disorder, pain, downregulated strength of muscle	Chronic	T11-12	11	Conservative	Improved
28	Female	52	Sensory disorder, downregulated strength of muscle	Chronic	C5-6	10	Conservative	Not Improved
29	Male	47	Sensory disorder, downregulated strength of muscle	Chronic	C4-5	25	Conservative	Not Improved
30	Female	54	Sensory disorder, downregulated strength of muscle	Chronic	C3-4	17	Conservative	Not Improved

表1

参考文献 17

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