- 期刊
Neural Sheath Tumors of the Brachial Plexus-22-year experience at Chang Gung Memorial Hospital
臂叢神經之神經鞘瘤－長庚醫院22年經驗
摘要
背景： 臂叢神經腫瘤發生率低，對重建專科醫師來說仍是個具有挑戰性的手術。 目的及目標： 此研究的目的是統計長庚過去二十年來的病例及分析臂叢神經神經鞘腫瘤在不同分類階層(level)的發生率、病理組織分類、特徵及臨床預後。 材料及方法： 長庚醫院從1987至2008年追溯性研究臂叢神經之神經鞘腫瘤共有62位，其中60位是良性腫瘤(96.8%)和2位是惡性腫瘤(3.2%)。我們根據不同的手術方式將臂神經叢分成四個階層：第一、節前神經根；第二、節後脊髓神經；第三、鎖骨前後神經叢；第四、鎖骨下臂神經叢 結果： 38個神經鞘瘤(Schwannoma)在平均追蹤2年後皆無復發。14個是孤立神經纖維瘤，在切除後只有一個在術後18年後復發。8個是多發性神經纖維瘤，有3個在平均追蹤6年內復發，而有1個病例在3年內復發3次且出現惡性變化。故言，神經纖維瘤的復發率爲18.2%而轉變成惡性的機率佔4.5% 結論： 良性之週邊神經鞘腫瘤(PNST)包含了神經鞘瘤及神經纖維瘤，雖然病理組織來源不同，但是兩者之治療大致相同且通常可治癒。惡性之神經鞘腫瘤則須行局部廣泛性切除或非手術之保守性療法治療。
關鍵字
無資料並列摘要
Background: Tumors of the brachial plexus are relatively rare and present a clinical challenge for the reconstructive plastic surgeon. Aim and objectives: The aim of the present study is to review and analyze the prevalence of the brachial plexus neural sheath tumor in different levels, histological subtypes, characteristics and clinical outcomes in the last twenty years. Materials and methods: This is a retrospective review of 62 peripheral neural sheath tumors (PNST) of the brachial plexus between 1987 and 2008 at the Chang Gung Memorial hospital. 60 cases (96.8%) were benign and 2 (3.2%) were malignant PNST. We classified our brachial plexus tumors into four level groups based on different surgical approaches. (1) level 1group: preganglionic root; (2) level 2 group: postpanglionic spinal nerve; (3) level 3 group: pre- and retro-clavicular; and (4) level 4 group: infraclavicular brachial plexus. Results: Of the 38 patients of schwannoma operation group in our series, no recurrence was observed with a mean follow-up of 2 years. Fourteen patients of solitary neurofibromas were excised and there is one recurrence after 18-year follow-up. 8 neurofibromatosis were excised and 3 have recurrent in a mean follow up of 6 years and one case has malignant change after three time recurrences and operations within 3 years. 18.2% (4/22) of recurrence rate and 4.5% (1/22) of malignant degeneration were found in our neurofibroma group of patients. Conclusion: Benign PNST, including schwannoma and solitary neurofibroma, are usually curative. Histology is different between both, but treatment is almost the same. Malignant PNST must be treated by either radical local resection or conservativeness.