摘要：

目的: 探讨儿童复杂脊髓脂肪瘤的分型和外科手术策略。方法: 选择2015年1月至2023年1月在清华大学附属北京清华长庚医院治疗的68例复杂脊髓脂肪瘤患儿，根据修-孙分型分为背侧型42例、过渡型15例、混杂型11例，均于神经电生理监测下行显微外科手术。评估术后1个月内（早期）及术后1年及以上（远期）疗效和安全性。结果: 早期疗效：根据Kirollos术中拴系松解分级评定法，61例（89.71%）脂肪瘤粘连松解程度达Ⅰ级，5例（7.35%）达Ⅱ级，2例（2.94%）达Ⅲ级；7例（10.29%）全切除，16例（23.53%）近全切除，45例（66.18%）大部切除。远期疗效：随访（5.00 ±0.20）年，神经功能评估，背侧型（χ²=0.364，P=0.549）、过渡型（χ²=0.125，P=1.000）、混杂型（χ²=1.500，P=0.219）患儿手术前后McCormick脊髓功能损伤分级系统比较差异均无统计学意义；影像学随访，6例（8.82%）复发；术后症状不同程度改善，无进展生存率达91.18%（62/68）。术后25例（36.76%）出现并发症，包括大小便障碍13例（19.12%）、肌力下降9例（13.24%）、脑脊液漏3例（4.41%）、中枢神经系统感染继发急性脑积水2例（2.94%），其中2例同时出现肌力下降和大小便障碍。结论: 修-孙分型对儿童复杂脊髓脂肪瘤的手术策略具有指导意义，背侧型和大部分过渡型可选择近全切除甚至全切除，混杂型和髓包瘤型建议以减瘤为主；所有类型脊髓脂肪瘤均应行拴系松解。

关键词: 脂肪瘤, 脊髓, 显微外科手术, 儿童

Abstract:

Objective: To discuss the classification and surgical treatment strategies of complex spinal lipoma in children. Methods: A total of 68 children with complex spinal lipoma were selected for treatment at Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University from January 2015 to January 2023. They were divided into dorsal type (n = 42), transitional type (n = 15) and chaotic type (n = 11) based on XIU-SUN classification. All patients underwent microsurgical treatment under neurophysiological monitoring. The early (within one month after surgery) and long-term (over one year after surgery) efficacy and safety of all patients were evaluated. Results: Early efficacy: according to the Kirollos grading method for intraoperative decompression, 61 cases (89.71%) reached level Ⅰ, 5 cases (7.35%) reached level Ⅱ, and 2 cases (2.94%) reached level Ⅲ; according to the degree of resection, complete resection was achieved in 7 cases (10.29%), subtotal resection in 16 cases (23.53%), and partial resection in 45 cases (66.18%). Long-term efficacy: all patients were followed up for (5.00 ±0.20) years. According to the McCormick spinal cord injury grading system, there was no statistically significant difference in the preoperative and postoperative neurological scores of the dorsal type (χ² = 0.364, P = 0.549), transitional type (χ² = 0.125, P = 1.000) and chaotic type (χ² = 1.500, P = 0.219). MRI examination revealed recurrence of lipoma in 6 cases (8.82%). The postoperative symptoms improved to different degrees, and the progression free survivial rate was 91.18% (62/68). Postoperative complications: 25 cases (36.76%) of postoperative complications were observed, including urinary and fecal dysfunction in 13 cases (19.12%), decreased muscle strength in 9 cases (13.24%), cerebrospinal fluid leakage in 3 cases (4.41%), central nervous system infection leading to acute hydrocephalus in 2 cases (2.94%), with 2 cases presenting with both decreased muscle strength and urinary and fecal dysfunction. Conclusions: XIU-SUN classification has a guiding role in surgical strategy. In cases of dorsal type and most of transitional types, a subtotal or complete resection can be chosen. For chaotic type and medullary type, a reduction-based approach is recommended. All types of spinal lipoma should undergo detachment release.

Key words: Lipoma, Spinal cord, Microsurgery, Child