颈静脉孔区肿瘤的手术治疗及预后

发布时间：2018-05-07 03:31

本文选题：颈静脉孔 + 肿瘤　；参考：《山东大学》2017年硕士论文

【摘要】：研究目的:探讨各种不同病理类型的颈静脉孔区肿瘤的临床特征、影像学特征、手术治疗策略、治疗效果、预后及预后不良的相关危险因素。研究方法:对山东省立医院西院2005年9月至2016年4月就诊的72例颈静脉孔区肿瘤患者的临床资料、随访信息进行回顾性分析。所有患者术前均行颈静脉孔区的影像学检查,包括CT、MRI、CTA检查,并根据情况选择血管造影和肿瘤供血血管栓塞。采用显微外科技术切除肿瘤,术后随访10～137个月。统计分析肿瘤的临床特点、影像学特点、病理分型、肿瘤分期,手术治疗效果,不同手术入路的应用及预后等;分别分析不同类型颈静脉孔区肿瘤的复发率;Logistic回归分析不同因素与肿瘤预后的相关性,涉及的危险因素包括肿瘤分期、病理类型、手术切除范围、术前出现面瘫、后组颅神经受损症状、年龄等。结果:72例临床资料中,就诊年龄为22-84岁,平均年龄46.7岁。女性多于男性,男性35名,女性37名。随访时间为61.32 ± 39.02个月(10～137个月),主要临床症状搏动性搏动性耳鸣48.6%,听力下降62.5%,周围性面瘫占37.5%,颈部肿块占6.9%,后组颅神经症状声嘶20.80%;呛咳20.8%;伸舌偏22.2%,软腭麻痹19.4%,耸肩无力8.3%,头疼占13.9%,平衡障碍占19.4%,外耳道溢液占20.8%,耳痛16.7%。本组72例肿瘤分类均为FISCH分型C级以上。其中66例行经颞下窝A入路颈静脉孔区肿瘤切除术,2例行颞下窝A入路联合迷路后入路,3例行颞下窝A入路联合乙状窦后入路,1例行颞下窝A入路联合经迷路入路肿瘤切除。60例全切除,12例次全切除,本组肿瘤的全切率为83.32%(60/72)。病理结果显示颈静脉副节瘤31例,占43.1%;神经鞘瘤12例,占16.7%;脑膜瘤4例,占5.6%,其中包括1例侧颅底异位间变脑膜瘤,1例颈静脉孔及右鼓室脑膜瘤;软骨肉瘤5例,占6.9%;内淋巴囊腺肿瘤4例,占5.6%;神经纤维瘤4例,占5.6%;鳞癌2例,占2.8%,其中1例伴乳突胆脂瘤;腺癌4例,占5.6%;巨细胞瘤1例,占1.4%;浆细胞瘤1例,占1.4%;恶性副节瘤2例,占2.8%;骨母细胞瘤1例,占1.4%;骨纤维结构异常1例,占1.4%;神经纤维瘤围手术期死亡1人。术后患者可出现听力丧失、面瘫、后组颅神经症状,但根据情况不同可逐渐缓解,副节瘤患者术后搏动性耳鸣多缓解。31例副节瘤总复发率为13.0%,全切复发率为9.5%,次全切复发率为50%,12例神经鞘瘤总复发率为8.3%,全切复发率为0,次全切复发率为33.3%;7例患者死亡,包括鳞癌2例,腺癌1例,浆细胞瘤1例,恶性副节瘤1例,间变脑膜瘤1例,神经纤维瘤1例术后猝死。就诊时已出现面瘫、后组颅神经症状,病理恶性程度越高,手术切除不完全增加了患者的复发率(*P0.05)。结论:1.颈静脉孔区肿瘤中颈静脉副节瘤、神经鞘瘤比较多见,又存在各种特殊的病理类型。2.规范的术前评估十分重要,对于确定正确的手术入路具有重要意义。3.颞下窝A入路肿瘤切除术,可以满足大多数颈静脉孔区肿瘤切除的要求。根据病变范围可联合迷路后,乙状窦后入路手术。4.不同病理类型肿瘤影像学特征可有其特异性表现,具有鉴别诊断价值。5.病理类型为恶性、后组颅神经受累、面神经受累、手术切除不完全为术后复发、预后不良的可能危险因素。
[Abstract]:Objective: To investigate the clinical features, imaging features, surgical treatment strategies, therapeutic effects, prognosis and poor prognosis of various pathological types of the jugular foramen area. The clinical data of 72 cases of jugular hole tumor in the West Hospital of Shangdong Province-owned Hospital from September 2005 to April 2016 were studied. A retrospective analysis of the information was performed. All the patients underwent an imaging examination of the jugular foramen area before operation, including CT, MRI, CTA, and selected angiography and blood vessel embolism. The tumor was excised by microsurgical technique and followed up for 10~137 months. The clinical features, imaging features and pathological classification of the tumor were statistically analyzed. Tumor staging, surgical treatment effect, application of different surgical approaches and prognosis, the recurrence rate of tumor in different types of jugular foramen was analyzed respectively. Logistic regression analysis was used to analyze the correlation between different factors and the prognosis of tumor. The risk factors included tumor staging, pathological type, surgical resection range, facial paralysis, and posterior cranial nerve. Results: in 72 cases, the age was 22-84 years and the average age was 46.7 years old. The average age was 46.7 years old. Women were more than men, 35 men and 37 women. The follow-up time was 61.32 + 39.02 months (10~137 months). The main clinical symptoms were pulsatile tinnitus 48.6%, hearing loss 62.5%, peripheral facial paralysis 37.5%, cervical mass accounted for 6.9%. The posterior group cranial nerve hoarseness 20.80%, choking 20.8%, the extension of the tongue 22.2%, the soft palate palsy 19.4%, the shrug weakness 8.3%, the headache 13.9%, the balance barrier 19.4%, the external auditory canal overflow 20.8%, the 16.7%. group of the auricular pain were all FISCH classification above C grade. 66 cases were performed by the infratemporal fossa A approach jugular foramen tumor resection, and 2 routine infratemporal. A approach combined with labyrinthine posterior approach, 3 routine subtemporal fossa A approach combined with retrosigmoid approach, 1 cases of subtemporal fossa A approach combined with trans labyrinthine tumor resection for total excision of.60 cases, 12 cases of total resection, the total resection rate of this group was 83.32% (60/72). Pathological results showed that 31 cases of jugular vein nodules were 43.1%, 12 cases of neurilemmoma, 16.7% and meningioma 4. 5.6%, including 1 cases of heterotopic meningioma of the lateral skull base, 1 cases of jugular hole and right tympanic meningioma, 5 cases of chondrosarcoma, 6.9%, 4 cases of endolymphatic cysts, 4 cases of neurofibroma, 5.6%, 2 cases of squamous cell carcinoma, 2.8%, 1 cases of papilloma cholesteatoma, 4 cases of adenocarcinoma, accounting for plasma cytomatoma. %, 2 cases of malignant secondary nodules, 2.8%, 1 cases of osteoblastoma, 1.4% of the osteoblastoma, 1 cases of bone fibrous structure, 1.4% and 1 people died in the perioperative period of neurofibroma. The postoperative patients could have hearing loss, facial paralysis, and the posterior group cranial nerve symptoms, but they could be gradually relieved according to the situation. The total recurrence of.31 cases with pulsatile tinnitus after surgery was relieved and the total recurrence of accessory nodules was relieved. The rate was 13%, the total recur rate was 9.5%, the subtotal recur rate was 50%, the total recurrence rate of the neurilemmoma was 8.3%, the total recur rate was 0, the subtotal recur rate was 33.3%, 7 patients died, including the squamous cell carcinoma 2, the adenocarcinoma 1, the plasma cytoma 1, the malignant subnodule 1 cases, the meningioma 1 cases, and the sudden death after the neurofibroma. The higher the malignant degree of the cranial nerve in the posterior group, the higher the pathological malignancy, the surgical excision does not increase the recurrence rate of the patients (*P0.05). Conclusion: 1. the jugular vein paraplasia in the tumor of the jugular hole area is more common, and there are various special pathological types of.2. specification before the operation evaluation is very important, for the determination of the correct surgical approach. Important significance.3. tumor resection of the infratemporal fossa A approach can meet the requirements of most jugular foramen excision. According to the range of the lesions combined with the labyrinth, posterior sigmoid sinus approach surgery for different pathological types of.4. tumor imaging features can be specific, the differential diagnostic value.5. pathological type is malignant, the posterior group cranial nerve Affected by facial nerve involvement, surgical resection is not entirely a possible risk factor for postoperative recurrence and poor prognosis.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.91

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