神经根型骶管囊肿静水压机制和手术疗效研究

Hydrostatic pressure mechanism of Tarlov cysts and the efficacy of surgical treatment

摘要:

目的 探讨神经根型骶管囊肿的囊内静水压机制及显微手术的临床疗效。方法 回顾性分析2016年11月—2019年6月在山西医科大学第二医院通过显微镜下神经束膜重建的手术方式治疗的26例神经根型骶管囊肿患者的临床资料，包括症状特点、术中处理及术后随访。选择该时间范围内的部分患者术中囊内静水压测量数据进行统计分析。结果 神经根型骶管囊肿患者以腰骶部和下肢疼痛为主要就诊症状。26例患者均接受囊肿大部切除及神经根束膜重建显微手术治疗，术后无新发并发症。其中25例患者症状改善或消失（96.1%），1例无明显变化。术前囊内压力数值在不同体位下波动于3.1～12.4 mmHg；术后骶管内压力降至0.1～0.8 mmHg。结论 神经根型骶管囊肿可能与囊内静水压升高有关。显微镜下囊肿切除联合神经束膜重建术可缓解症状，是治疗神经根型骶管囊肿有效而安全的方法。

Abstract:

Objective To investigate the intracystic hydrostatic pressure mechanism of Tarlov cyst and the clinical efficacy of microsurgery.Methods A retrospective analysis was performed for the clinical data of 26 patients with Tarlov cysts who underwent surgical treatment in The Second Hospital of Shanxi Medical University from November 2016 to June 2019， including symptoms， intraoperative management， and postoperative follow-up. Intracystic hydrostatic pressure was measured for some patients during surgery， and a statistical analysis was performed.Results Lumbosacral pain and radiating pain in the lower extremities were the main symptoms of the patients with Tarlov cysts when they attended the hospital. All 26 patients underwent microsurgery involving subtotal cyst resection and nerve root fascicular reconstruction， and there were no new complications after surgery. Of all patients， 25 （96.1%） achieved the improvement or disappearance of symptoms， and 1 had no significant changes. Preoperative intracystic pressure ranged from 3.1 to 12.4 mmHg under different body positions， whereas sacral canal pressure ranged from 0.1 to 0.8 mmHg after surgery.Conclusions Tarlov cysts may be associated with the increase in intracystic hydrostatic pressure. Microsurgical subtotal cyst resection combined with nerve root fascicular reconstruction can alleviate symptoms and is a safe and effective method for the treatment of Tarlov cysts.