鞍区占位病变758例临床分析及鞍区手术入路显微解剖研究

发布时间：2018-05-05 02:02

  本文选题：鞍区 + 占位病变　； 参考：《天津医科大学》2005年硕士论文

【摘要】：目的:总结758例鞍区占位病变的临床资料,并结合对尸体头颅标本的鞍区显微解剖研究,提高对鞍区解剖、鞍区手术和鞍区病变的认识水平,用以指导和改进临床工作。 方法:一、回顾性分析758例鞍区占位病变的性别、年龄、临床表现、影像学资料、病理特点、治疗和术后并发症情况,总结经验教训。 二、利用CT对鞍区相关径线进行测量。借助手术显微镜对尸头标本进行鞍区手术入路和鞍区显微解剖的研究。 结果:本组758例鞍区病变,占同期颅内占位病变的23.7%,共包括27种病变,其中垂体腺瘤544例(71.8%),颅咽管瘤69例(9.1%),脑膜瘤42例(5.5%),其他共103例(13.6%)。经蝶手术是治疗垂体瘤较好的选择,翼点入路是治疗鞍上病变的理想术式。鞍区解剖研究中,描述和测量了蝶鞍的相关径线及鞍区显微手术间隙。 结论:鞍区病变的发生率高,且种类繁多、表现相似,临床工作中容易误诊。通过总结分析,加强对该区域疾病的认识,提高术前确诊率,有利于改善预后。鞍区所在部位深在,解剖结构复杂,神经、血管众多且毗邻许多重要结构,如垂体柄、下丘脑等。术者应熟悉鞍区的显微解剖,鞍区手术中,间隙Ⅰ、Ⅱ是最常用的间隙(间隙Ⅰ为视交叉前间隙;间隙Ⅱ为视神经、颈内动脉和大脑前动脉间隙。);间隙Ⅲ、Ⅳ多配合间隙Ⅰ、Ⅱ来完成手术(间隙Ⅲ为颈内动脉、小脑幕游离缘间隙;间隙Ⅳ为打开终板所得的间隙。),保护深穿支血管、下丘脑和垂体柄等是获得良好疗效的关键。
[Abstract]:Objective: to summarize the clinical data of 758 cases of Sella area occupying lesions, and to improve the understanding level of Sella region anatomy, Sella surgery and Sella area lesions, and to improve the clinical work. Methods: 1. The sex, age, clinical manifestation, imaging data, pathological features, treatment and postoperative complications of 758 patients with Sellar area occupying lesions were analyzed retrospectively. Second, CT was used to measure the relative diameter of Sellar region. The surgical approach and microanatomy of the cadaveric head were studied by means of surgical microscope. Results: there were 758 cases of Sellar lesions, accounting for 23.7% of intracranial space-occupying lesions in the same period. There were 27 kinds of lesions, including pituitary adenoma in 544 cases, craniopharyngioma in 69 cases, meningioma in 42 cases, and others in 103 cases. Transsphenoidal surgery is a better choice in the treatment of pituitary adenoma, and pterygoid approach is an ideal method for the treatment of suprasellar lesions. In the anatomical study of the Sellar region, the correlation diameters of Sella turcica and the microsurgical space in the Sellar region were described and measured. Conclusion: the incidence of Sellar lesions is high, and there are many kinds of Sellar lesions with similar manifestations, and it is easy to be misdiagnosed in clinical work. Through summing up and analyzing, it is helpful to improve the prognosis by strengthening the understanding of the disease in this area and raising the rate of preoperative diagnosis. The Sellar region is located deep, complex anatomical structure, numerous nerves and blood vessels, and adjacent to many important structures, such as pituitary stalk, hypothalamus and so on. The operation should be familiar with the microanatomy of the Sellar region. In the operation of the Sellar region, the space 鈪，

本文编号：1845673