骶管囊肿的治疗及发病机制的探讨（附25例病例报告）

Treatment and pathogenesis of intrasacral canal cyst: report of 25 cases

摘要:

目的  呈现开放性手术治疗骶管囊肿的更多细节，并进一步探讨其发病机制。方法  选取2010～2014年就诊的症状性骶管囊肿患者予以椎板切除减压、囊壁切开引流、带蒂旋转竖脊肌瓣充分填塞覆盖治疗，术中取囊壁标本行病理学检查。结果  治疗后19例（76.0%）术后症状完全缓解，3例（12.0%）症状部分缓解，1例（4.0%）病情无变化。标本行苏木精-伊红染色法（HE）染色，镜下无神经组织，仅观察到薄层玻变的胶原纤维，局部出血，内衬单层扁平上皮细胞。免疫荧光检测S100及神经胶质纤丝酸性蛋白，呈阴性。结论  骶管囊肿并非来自于先天性硬脊膜发育异常，而是后天创伤引起的马尾神经束膜样结构扩张。开放性外科手术治疗骶管囊肿疗效确切，是一种良好的外科治疗策略。

Abstract:

Objective To present more details for treating sacral canal cyst by open surgery, and to probe into the pathogenesis. Methods The patients with symptomatic sacral canal cyst from 2010 to 2014 were treated with laminectomy and decompression, incision and drainage of the cyst, rotating erector spinae pedicle flap and full padding. Appropriate wall tissue was removed for pathological examination. Results All patients received an open surgery, 76.0% (19/24) of the patients showed complete remission of the symptoms, 12.0% (3/24) showed partial improvement, and 4.0% (1/24) had no improvement. There was no nervous tissue under microscope, but a thin layer of hyaline-degenerated collagen fibers with hemorrhage lined with monolayer squamous epithelial cells. The immunofluorescence analysis showed glial fibrillary acidic protein and S100 were negative. Conclusions Sacral canal cyst is not derived from congenital defect of dura mater spinalis, but from an expansion of perineurium-like structure (similar to peripheral perineurium) covering the surface of cauda equina. The curative effect of open surgery is accurate and the management could be used as a favorable surgical option.