上胸段椎管内血管脂肪瘤伴截瘫1例

2017-12-04 佚名 中国脊柱脊髓杂志

患者女,23岁。

【一般资料】

患者女,23岁。

【主诉】

因“突发双下肢感觉活动障碍6d”于2016年11月14日来院。

【现病史】

患者于6d前、二胎顺产后第四天突发胸背痛并双下肢感觉运动障碍,于当地医院急诊观察室住院行激素冲击、营养神经等治疗,症状无好转,行MRI检查T2~T4水平椎管内硬膜外背侧可见“梭形异常信号”,边界尚清楚,其纵轴与脊髓走向一致,T1WI为低信号,T2WI为略低于脑脊液的高信号。患者为进一步诊治来我院就诊。

【既往史】

患者5年前有两次胸背部疼痛伴双下肢感觉、运动障碍病史,曾于骨科、神经内科住院治疗,胸椎MRI平扫及增强未见明显异常(图1、2),考虑为脊髓血管畸形、脱髓鞘病变可能,予激素冲击、营养神经等对症治疗后症状逐渐消失。

【体格检查】

乳头平面以下感觉消失(S0级),双下肢肌力0级,肌张力不高,肛门括约肌松弛,肛门反射、腹壁反射、双侧膝反射、踝反射消失,巴彬斯基征、奥本汉姆征未引出,髌阵挛、踝阵挛试验阴性。

【辅助检查】

患者入院后积极完善常规检查及肿瘤指标检测;MRI平扫示T2~T4水平椎管内硬膜外长梭形占位,增强扫描示不均匀强化(图3~6),CT示颈胸段椎管内均匀密度改变,椎管未见明显骨质异常。

【治疗】

排除手术禁忌证,入院2d后在全麻下行T1~T5全椎板切除减压、肿瘤切除术,术中见T2~T4硬膜外有一棕红色肿物伴凝血块形成,肿瘤长约87.5px,质软,类似于脂肪组织,血供丰富,边界清楚,与硬脊膜无明显粘连,易于完整剥离,相应节段硬膜及脊髓受压明显,搏动性差。术中完整切除肿瘤组织,标本送病理检查。术后病理检查报告:血管脂肪瘤伴灶性出血(图7)。术后1周,患者出院前双下肢感觉恢复至S1级,双下肢肌力恢复至1~2级,大小便失禁。至术后2个月复查时,患者自觉症状较前明显好转,麻木平面下移,双下肢感觉减退,肌力约2级。半年随访,未见肿瘤复发(图8、9)。


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    2018-02-06 bugit
  3. [GetPortalCommentsPageByObjectIdResponse(id=1724227, encodeId=3be31e242274e, content=<a href='/topic/show?id=71c1628e901' target=_blank style='color:#2F92EE;'>#椎管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62879, encryptionId=71c1628e901, topicName=椎管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d4e33593434, createdName=caobinglei8090, createdTime=Mon Jan 22 22:38:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1690757, encodeId=27e01690e57be, content=<a href='/topic/show?id=de3362880f1' target=_blank style='color:#2F92EE;'>#椎管内#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62880, encryptionId=de3362880f1, topicName=椎管内)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae6d29130493, createdName=bugit, createdTime=Tue Feb 06 15:38:00 CST 2018, time=2018-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=269396, encodeId=d7bc26939631, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Thu Dec 14 17:17:44 CST 2017, time=2017-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1384776, encodeId=c71b1384e76e4, content=<a href='/topic/show?id=27348436847' target=_blank style='color:#2F92EE;'>#脂肪瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84368, encryptionId=27348436847, topicName=脂肪瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=afdf491, createdName=lilili1104, createdTime=Wed Dec 06 08:38:00 CST 2017, time=2017-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267104, encodeId=355726e104b9, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Tue Dec 05 23:18:49 CST 2017, time=2017-12-05, status=1, ipAttribution=)]
    2017-12-14 天涯183

    非常好的文章.学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1724227, encodeId=3be31e242274e, content=<a href='/topic/show?id=71c1628e901' target=_blank style='color:#2F92EE;'>#椎管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62879, encryptionId=71c1628e901, topicName=椎管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d4e33593434, createdName=caobinglei8090, createdTime=Mon Jan 22 22:38:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1690757, encodeId=27e01690e57be, content=<a href='/topic/show?id=de3362880f1' target=_blank style='color:#2F92EE;'>#椎管内#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62880, encryptionId=de3362880f1, topicName=椎管内)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae6d29130493, createdName=bugit, createdTime=Tue Feb 06 15:38:00 CST 2018, time=2018-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=269396, encodeId=d7bc26939631, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Thu Dec 14 17:17:44 CST 2017, time=2017-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1384776, encodeId=c71b1384e76e4, content=<a href='/topic/show?id=27348436847' target=_blank style='color:#2F92EE;'>#脂肪瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84368, encryptionId=27348436847, topicName=脂肪瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=afdf491, createdName=lilili1104, createdTime=Wed Dec 06 08:38:00 CST 2017, time=2017-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267104, encodeId=355726e104b9, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Tue Dec 05 23:18:49 CST 2017, time=2017-12-05, status=1, ipAttribution=)]
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    2017-12-05 天涯183

    非常好的文章.学习了

    0

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