摘要
目的探讨儿童脊髓髓内占位病变(IMSCT)的临床特征。方法对本院确诊为IMSCT的16例患儿性别、发病年龄、病变部位、病理组织学类型、首发症状、主要临床表现、特殊阳性体征、辅助检查如X线、CT、MRI、直肠肛管、测压、神经传导速度等临床资料进行回顾性分析。结果16例中男11例,女5例;年龄15个月～14岁,平均(8.55±4.28)岁。从发病到确诊的时间为1d～9a,平均2.23a。首发症状以疼痛最为常见。主要症状:肢体运动障碍14例,疼痛12例,二便障碍9例,步态异常8例,肢体萎缩3例。体格检查:腱反射异常14例,浅反射消失9例,肛门括约肌松弛6例,巴氏征阳性5例,脊柱畸形4例,局部包块3例,感觉异常2例,双下肢不等长、潜毛窦、色素沉着各1例。患儿均行脊髓MRI检查,均有病变段脊髓增粗和髓内异常信号区。病理类型:畸胎瘤5例,皮样囊肿、表皮样囊肿各2例。误诊为尿路感染2例,类风湿关节炎、腰椎间盘突出各1例。结论儿童IMSCT以先天性肿瘤为主,首发症状多为疼痛,MRI检查为其诊治提供了可靠依据。早期发现、早期诊断、早期治疗对改善本病的预后至关重要。
Objective To investigate the clinical features of intramedullary spinal cord tumors （IMSCT） in children. Methods The clinical data including sex,age,pathohistology,clinical manifestations and medical checkup collected from 16 children diagnosed as IMSCT in Shengjing Hospital Affiliated to China Medical University,were retrospectively reviewed and analyzed. Results The study subjects included 11 male and 5 female,with an average age of （8.55 ± 4.28） years old, ranged from 15 months to 14 years old. The interval lasted 1 day to 9 years from onset of the syndrome to confirmed diagnosis of IMSCT. The first clinical manifestation was mostly pain. The main clinical manifestations included limb dyskinesia in 14 cases,pain in 12 cases, urine and stool disturbance in 9 cases,gait irregularity in 8 cases,extremity atrophy in 3 cases. Medical check - up included abnormal tendon reflex in 14 cases,abnormal superficial reflex in 9 cases, sphincter dilatation in 6 cases,positive Babinski＇s signs in 5 cases, spinal deformity in 4 cases, region masses in 3 cases, paraesthesia in 2 cases,inequality of lower limb in I case,dermal sinus in 1 case,pigmentation in 1 case. The cases were evaluated by magnetic resonance imaging, which presented thickened spinal cord and intramedullary abnormal signals in all the cases. Pathological types： teratoma in 5 cases,dermoid cysts in 2 cases, epidermoid cyst in 2 cases. Misdiagnoses included urinary tract infections in 2 cases,rheumatoid arthritis in 1 ease, and lumbar disc protrusion in 1 case. Conclusions The main pathohistology of pediatric IMSCT is congenital tumor. First clinical manifestation is pain. MRI can show a reliable evidence for the diagnosis. It is important to improve the outcomes of pediatric IMSCT by establishing the diagnosis and administering proper management as early as possible.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2008年第23期1850-1852,共3页
Journal of Applied Clinical Pediatrics
关键词
脊髓髓内占位病变
临床特征
儿童
intramedullary spinal cord lumors
clinical features
child
