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Jingdong book

脊髓肿瘤外科学

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Jingdong book

脊髓肿瘤外科学

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《脊髓肿瘤外科学》内容丰富，为您提供最新、最全面的脊髓肿瘤外科基础知识与临床技术。在《脊髓肿瘤外科学》各章节中，对当前脊髓肿瘤外科的重点和热点问题，都加以清晰、精确且详尽的描述，使每一位读者都会受益匪浅。
Author Description

王振宇，北京大学第三医院教授、主任医师、博士生导师、神经外科主任。兼任中华医学会神经外科学会脊髓脊柱专业组副组长、北京医师协会神经外科专科医师分会副会长、北京医学会神经外科专业委员会委员、中国医师协会神经外科分会脊髓脊柱专家委员会委员、北京医师协会神经外科专家委员会委员。《中华神经外科疾病研究杂志》、《中华神经医学杂志》、《中国临床神经外科杂志》、《中国微创外科杂志》、《中华老年心脑血管病杂志》编委。在神经外科疾病诊断及治疗方面积累有丰富的临床经验，尤其擅长颅内肿瘤、各种复杂疑难脊髓肿瘤、脊髓空洞、脊髓先天性畸形等疾病的微创手术治疗。在降低患者病残率、提高患者生存质量方面做了大量卓有成效的工作，具有许多成功的经验。曾先后在国内率先完成了开放血脑屏障化疗恶性脑瘤、神经组织移植促进脊髓损伤后再生修复的系列研究。目前承担的科研课题有：恶性脑肿瘤综合治疗的基础与临床研究、中枢神经系统损伤后的可塑性研究、脊髓空洞发生机制的研究、出血性脑卒中早期诊断与早期治疗研究、脊髓手术术中监测研究等。在国内外医学期刊发表学术论文八十余篇，获得省部级科技成果奖十一项。参加编写的专著有：《立体定向放射神经外科学》、《颅底神经外科学》、《神经外科手术学》、《神经外科疾病定位诊断学》、《神经外科手术入路图谱》、《神经系统肿瘤学》等。
Catalogue

第一章 脊柱、脊髓解剖与生理
第一节 脊柱
第二节 脊膜
第三节 脊髓和脊神经
第四节 脊髓的血管

第二章 脊髓肿瘤相关的脊柱生物力学
第一节 脊柱的基本生物力学
第二节 影响脊柱稳定性的因素
第三节 脊髓肿瘤手术后影响脊柱稳定性的因素
第四节 术后脊柱不稳定的预防
第五节 脊柱不稳定的诊断
第六节 脊柱不稳定的治疗

第三章 脊髓肿瘤术中神经电生理监测技术
第一节 术中神经电生理监测的目的和基本原理
第二节 术中神经电生理监测的解剖基础及基本监测方法
第三节 术中神经电生理监测在脊髓手术中的应用
第四节 术中神经电生理监测的影响因素

第四章 脊髓肿瘤总论
第一节 概述
第二节 脊髓肿瘤的分类
第三节 发病机制与病理生理学
第四节 临床表现
第五节 影像学检查
第六节 诊断与鉴别诊断
第七节 治疗
第八节 预后

第五章 硬脊膜外肿瘤
第一节 概述
第二节 病因与病理
第三节 临床表现
第四节 影像学检查
第五节 诊断与鉴别诊断
第六节 治疗
第七节 预后

第六章 硬脊膜内髓外肿瘤
第一节 概述
第二节 病因与病理
第三节 临床表现
第四节 影像学检查
第五节 诊断与鉴别诊断
第六节 手术治疗
第七节 辅助治疗
第八节 预后

第七章 脊髓髓内肿瘤
第一节 概述
第二节 流行病学与病理
第三节 临床表现
第四节 影像学检查
第五节 诊断与鉴别诊断
第六节 手术治疗
第七节 辅助治疗
第八节 预后

第八章 圆锥马尾部肿瘤
第一节 概述
第二节 流行病学
第三节 临床表现
第四节 影像学检查
第五节 诊断
第六节 手术治疗
第七节 手术并发症及防治
第八节 预后

第九章 哑铃型肿瘤
第一节 概述
第二节 临床表现
第三节 影像学检查
第四节 诊断与鉴别诊断
第五节 手术治疗
第六节 手术并发症及防治
第七节 预后

第十章 颅颈交界区肿瘤
第一节 概述
第二节 流行病学
第三节 临床表现
第四节 影像学检查
第五节 诊断与鉴别诊断
第六节 手术治疗
第七节 预后

第十一章 多发脊髓肿瘤
第一节 概述
第二节 临床表现
第三节 手术原则和术中可能碰到的问题

第十二章 合并脊柱畸形的复发性脊髓肿瘤
第一节 流行病学
第二节 脊柱畸形的易发因素
第三节 临床表现
第四节 预防与治疗

第十三章 椎旁肿瘤
第一节 概述
第二节 临床表现
第三节 影像学检查
第四节 诊断
第五节 手术治疗

第十四章 假性脊髓肿瘤
第一节 骶管囊肿
第二节 硬脊膜囊肿
第三节 脊髓囊虫病
第四节 椎管内脓肿及肉芽肿病变
第五节 椎管内脱垂游离型间盘
第六节 自发性椎管内血肿
第七节 肠源性囊肿
索引
Book Abstract

三、脊髓因素
（一）机械性压迫
脊髓及神经根受压之初，先是神经根受牵拉，脊髓移位、变形，直至出现水肿、变性、坏死和软化等，损伤局限在受压节段。髓外病变多先压迫、牵拉病变邻近的神经根，刺激脊膜，脊髓压迫首先从一侧开始逐渐发展至对侧，临床常有半侧脊髓损害的表现。髓内病变由内部向周围压迫，较早出现脊髓横贯损害的症状。脊髓各部位对压力的耐受性也有所不同，灰质比白质的耐受性大；白质中传导触觉和本体觉的神经纤维粗（5～12μm），传导痛觉的纤维细（小于2μm），受压后细纤维较粗纤维耐受性好，压迫解除后恢复也较快。
（二）脊髓血液循环
肿瘤压迫邻近的根动脉和软脊膜的小动脉使之发生狭窄和闭塞，该区脊髓供血不足、缺氧和营养障碍，引起脊髓变性、软化及坏死，此种缺血性坏死范围常超过肿瘤压迫的节段，病变压迫脊髓静脉则引起血液回流受阻发生淤血、水肿，乃至进一步的损害。在耐受缺氧方面，白质比灰质耐受性大，细神经纤维比粗神经纤维耐受性好。在脊髓受压早期，血液循环障碍是可逆性的，如能及时去除病因，脊髓功能障碍可完全恢复；当发生脊髓变性与软化时，脊髓功能障碍将不可逆转。
（三）肿瘤对脑脊液循环的影响
随着肿瘤的增大，脊髓蛛网膜下腔逐渐被阻塞，在阻塞平面以下，脑脊液搏动消失而压力降低，造成梗阻平面上下的压力不同。突然用力（如咳嗽）或腰椎穿刺放液时上下压力差剧增，由此可引起病变移动而使疼痛加剧或症状恶化，称为脑脊液冲击征或疝入征。髓外硬脊膜外压迫造成硬脊膜囊移位，瘤侧和对侧的脊髓蛛网膜下腔均狭窄。髓外一硬脊膜下压迫仅有脊髓移位而硬脊膜囊位置不变，瘤侧脊髓蛛网膜下腔增宽而对侧狭窄。由于病变周围血脑屏障破坏，蛋白质、胆红素等渗出，同时梗阻会影响大分子的吸收，导致脑脊液蛋白含量增高。
第四节 临床表现
一、椎管内肿瘤的临床分期
肿瘤引起脊髓压迫的临床过程分为三个阶段：刺激期、脊髓部分受压期和脊髓完全受压期。
（一）刺激期
病变早期肿瘤较小时，主要构成对神经根和硬脊膜的刺激，表现为神经根痛或运动障碍。神经根痛常为髓外占位病变的首发定位症状。60％～70％的肿瘤位于脊髓后方或后侧方，少数位于前方或前侧方，故病变早期神经根易受刺激引发疼痛。也可有局部麻木、发痒或灼热感等异常感觉。夜间痛或平卧痛是椎管内肿瘤较为特殊的症状，病人常被迫“坐睡”。但如髓外肿瘤影响到脊髓前角或前根脊神经，可产生相应节段的肌群无力、肌震颤等。
（二）脊髓部分受压期
肿瘤直接压迫脊髓，出现脊髓传导束受压症状，表现为受压平面以下肢体运动和感觉障碍。由于运动神经纤维较感觉神经纤维粗，容易受压力的影响而较早地出现功能障碍。由于皮质脊髓束和脊髓丘脑束在脊髓内的排列是颈部、上肢、躯干和下肢顺序依次由内向外排列，所以髓外肿瘤对脊髓压迫，是由下向上发展，最后到达肿瘤压迫的节段；而髓内肿瘤压迫症状则相反，呈由上向下发展趋势。脊髓部分受压的典型体征为脊髓半切综合征（Brown—Sequard's Syndrom），表现为病变阶段以下，同侧上运动神经元性瘫痪及触觉深感觉减退，对侧病变平面2～3阶段以下的痛温觉丧失。腰髓以下不会出现这种综合征。
……

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