诱导电位监测在脊髓内肿瘤手术治疗中的应用价值分析

王立园  卢恒聪  曹志恺  庄京文

[摘要] 目的 探讨诱导电位监测在脊髓内肿瘤中的应用。方法 对我科在2011年1月～2013年12月期间收治的14例脊髓内肿瘤患者行肿瘤切除术，术中采用SEP监测脊髓功能，采用EMG监测确定肿瘤切除范围。结果 14例手术患者自发性EMG监测正常，且在手术中采用激发性EMG后顺利判别“安全地带”，防止手术张出现“危险操作”。SEP监测出现异常数据9例，其中7例病患均出现SEP振幅下降了10%～30%，观察者即刻告知主治医生并找明原因，在降低刺激、压迫和牵拉等动作次数后10～20min，SEP回归至术前水平；另外2例在手术中SEP振幅跌至50%以下，在手术停止30min后恢复至术前水平，并成功继续完成手术。SEP监测手术中，共9例患者发生监测异常，其中7例患者SEP振幅下降了10%～30%，监测者立即提供手术医生并积极寻找下降原因，在减少牵拉、刺激和压迫等操作后10～20min，SEP恢复至术前水平；另外2例在手术中SEP振幅跌至50%以下，在手术停止30min后恢复至术前水平，并成功继续完成手术。肿瘤全部切除的11例，大部分切除3例，手术后12例神经症状无加重，手术中SEP振幅跌至50%以下的2例患者手术后神经症状明显加重，其中1例进行神经营养药物治疗和甲基强的松龙治疗持续7～10d后神经症状显著减轻并恢复至手术前水平，另1例为神经胶质瘤，症状改善不明显。结论 应用诱导电位监测能够提高肿瘤切除率，避免神经损伤，具有较高的应用价值。

[关键词] 脊髓内肿瘤；诱导电位监测；手术

[中图分类号] R739.4   [文献标识码] B   [文章编号] 2095-0616（2014）08-194-04

Analysis of applied value of induced potential monitor in the surgery of intramedullary tumor

WANG Liyuan  LU Hengcong  CAO Zhikai  ZHUANG Jingwen

Department of Neurosurgery, Guangzhou First People's Hospital,Guangzhou 510180,China

[Abstract] Objective To explore the application of inducing potential monitoring in surgery ofintraspinal tumor. Methods 14 patients received from January 2011 to December 2013 were were treated by tumor resection, which underwent SEP to monitorspinal cord function, and EMG to determine tumor resection. Results Spontaneous EMG of 14 patientsshowed no abnormalities. EMG was used to determine the safe zone to avoided dangerous operation.SEP showed abnormalities in 9 cases during operation, of these 7 cases had SEP amplitude decreasing of 10%～30%, which was detected by physician. After corresponsiveintervention, SEP returned to preoperative levels 10～20min later. The SEP amplitude of 2 cases within tramedullary tumors decreased over 50%.After ceasing operation for 30mins, SEP recovered a little, and operation continued. 11 tumors were removed completely, while 3 tumors were performed partial resection.2 cases suffering from SEP amplitude decreasing over 50% in operation had neurofunction deteriorated, of them 1 case had neurofunction recovered to preoperative level after corresponsive intervention 7～10 days later, while 1 case showed no improvement.Conclusion Induceing potential monitoring can improve the detection rate of tumor resection, avoid nerve damage, and have a great value.

[Key words] Intraspinal tumor;Inducing potential monitoring;Surgery

脊髓内肿瘤是椎管内肿瘤的一种，其临床发病率占到椎管肿瘤发病率的20%左右，为临床上较为少见的疾病[1]。……