听神经瘤面神经和听神经的功能保留

发布时间：2018-03-14 01:03

  本文选题：神经瘤　切入点：听　出处：《中国人民解放军医学院》2016年博士论文　论文类型：学位论文

【摘要】：本课题组近些年来在听神经瘤面神经和听神经的功能保留方向进行了探索和经验总结,本文将从这两个方面进行阐述。第一部分听神经瘤手术面神经的功能保留目的探讨听神经瘤手术面神经功能的保留术式和影响因素。方法采用队列研究方法对152例听神经瘤患者进行手术切除和术后面神经功能观察。对三种手术入路的面神经功能保留结果进行比较。采用Logistic回归模型分析听神经瘤术后即刻和长期的面神经功能保留与手术入路、肿瘤大小、年龄、性别、肿瘤与面神经粘连程度等方面的相关性.结果在152例听神经瘤患者中,97.4%的患者存在耳聋,88.2%存在耳鸣,眩晕的发生率为32.2%,面部麻木及皮肤感觉异常24.3%,步态不稳占13.2%,耳痛11.8%,复视3.9%,饮水呛咳2.6%。肿瘤的最大直径平均为2.34±1.14cm。面神经解剖保留完整者145例(占95.4%)。术后第7天经迷路入路对面神经功能的保留与经乙状窦后入路和颅中窝入路比较有差别,而经乙状窦后入路和经颅中窝入路对于面神经功能的保留无差别。术后1年三种手术入路对于面神经功能的保留均无差别。经Logistic回归模型多元分析发现术后第7天面神经的功能保留与手术入路和肿瘤与面神经的粘连程度有关,与患者年龄、性别、肿瘤大小无关；术后1年面神经功能的保留与患者年龄、肿瘤与面神经的粘连程度有关,与手术入路、肿瘤大小、性别无关。结论1、听神经瘤术后即刻经迷路入路对于面神经功能的保留优于经乙状窦后入路和颅中窝入路,而经乙状窦后入路和经颅中窝入路对面神经功能的保留无差别.三种手术入路对于面神经功能的长期保留均无差别.2、听神经瘤术后即刻面神经的功能保留与手术入路和肿瘤与面神经的粘连程度有关,与患者年龄、性别、肿瘤大小无关；术后长期的面神经功能保留与患者年龄、肿瘤与面神经的粘连程度有关,与手术入路、肿瘤大小、性别无关.第二部分听神经瘤听神经的功能保留目的探讨听神经瘤听神经功能的保留策略。方法采用随访观察、显微外科手术切除、立体定向放射治疗对54名中小听神经瘤患者进行个性化保留听力的尝试。 结果在听神经瘤的听力保留方面我们随访观察了27名小听神经瘤患者,24名(88.9%,24/27)患者肿瘤生长缓慢乃至不生长,继续观察随访,3例患者因肿瘤增长过快终止观察,其中2例患者给予手术切除,1例患者给予伽玛刀治疗。这例伽玛刀治疗患者,治疗后随访观察3年肿瘤没有增长,听力得到了很好的保留。课题组还对29例中小听神经瘤患者进行了保留听力的手术治疗,其中27例采用了经乙状窦后入路,2例采用了经颅中窝入路。听神经瘤术后即刻听力保留率55.2%(16/29)(A+B级听力)。其中,听力A级的为7例43.8%(7/16),B级的为9例56.3%(9/16)。术前听力为A级的患者,术后即刻听力保留率为78.6%(A+B级听力),其中保留A级听力者50.0%(7/14),B级听力者28.6%(4/14),C级者14.3%(2/14),D级者7.1%(1/14)。术前B级听力的患者,术后即刻听力保留率为(33.3%,5/15)(B级听力),C级者53.3%(8/15),D级者13.3%(2/15)。术后1-3年随访观察,在术后即刻保留听力的16名患者中,有14例87.5%(14/16)术后听力保留稳定,有2例12.5%(2/16)患者听力在随访的三年内出现了下降,分别由A级降为B级和由B级降为C级. 结论1、患者术前的听力级直接影响手术的听力保留率,因此,对听神经瘤的早发现、早诊断、早治疗,在听力为A级时就及时地给予手术是手术成功保留听力的关键。2、当随访观察的过程中发现肿瘤体积增长过快或实用听力可能要很快丧失的情况下,只要患者的全身情况允许,还是要积极的给予手术治疗,不要优柔寡断地错失保留听力的最后时机。
[Abstract]:The research group in recent years in acoustic neuroma facial nerve and auditory nerve function preservation are explored and summed up the experience, this paper will elaborate on these two aspects. To investigate the factors to the function of facial nerve neuroma surgery reservation operation and influence to reserve the first part function of the facial nerve in acoustic neuroma surgery. Methods by using the method of queue study on the observation of facial nerve function after surgical resection and 152 cases of patients with acoustic neuroma surgery. To compare the results of three surgical approaches to the preservation of facial nerve function. Logistic regression model was used to analyze acoustic neuroma surgery immediately after and long-term preservation of facial nerve function and surgical approach, tumor size, age, gender, tumor correlation with the facial nerve adhesion degree etc.. Results in 152 cases of patients with acoustic neuroma, 97.4% were deaf, 88.2% tinnitus, vertigo occurred in 32.2% face Department of numbness and paresthesia in 24.3%, gait instability accounted for 13.2%, 11.8% and 3.9% earache, diplopia, hydroposia 2.6%. average tumor diameter was 2.34 + 1.14cm. facial nerve intact in 145 cases (95.4%). After seventh days the translabyrinthine approach retains the function of facial nerve and retrosigmoid approach and middle cranial fossa are different, and by retrosigmoid approach and retention by middle fossa approach for facial nerve function showed no difference. 1 years after the operation of three kinds of surgical approach for facial nerve function preservation was not different. By Logistic regression model in operation after seventh days of facial nerve function preservation and adhesion degree of surgical approach and tumor and facial nerve, gender and age of patients, regardless of tumor size, patient age 1 years; retention and postoperative facial nerve function, the degree of adhesion of tumor and facial nerve associated with surgical approach, tumor The size, regardless of gender. Conclusion 1, acoustic neuroma surgery immediately after the reservation is better than the translabyrinthine approach for facial nerve function by retrosigmoid approach and middle cranial fossa, and by retrosigmoid approach and retention of the middle cranial fossa of facial nerve function had no difference between the three kinds of operation. Approach for long-term retention of facial nerve function showed no significant difference in.2, acoustic neuroma surgery after facet nerve function associated with the degree of adhesion retention of surgical approach and tumor and facial nerve, gender and age of patients, tumor size, independent; postoperative long-term preservation of facial nerve function and the age of patients, the degree of adhesion and tumor the facial nerve associated with surgical approach, tumor size, regardless of gender. The second part acoustic neuroma auditory nerve Objective: To investigate the function of acoustic neuroma hearing preservation strategy of neural function preserving. Methods observation, microsurgical resection and stereotactic radiotherapy The treatment of 54 patients with acoustic neuroma and personalized hearing preservation attempt. Results in acoustic neuroma hearing preservation we observed 27 small acoustic neuroma patients, 24 (88.9%, 24/27) in patients with tumor growth and even slow growth, continue to observe the follow-up, 3 patients with tumor growth termination observation of which 2 cases were treated with surgical resection, 1 cases were treated with gamma knife treatment. The cases of gamma knife in the treatment of patients with follow-up after treatment for 3 years without tumor growth, hearing is well preserved. The research group of 29 cases and listen to the tumor patients underwent surgery to preserve hearing, of which 27 cases were treated with the retrosigmoid approach, 2 cases by middle cranial fossa. Acoustic neuroma surgery immediately after hearing preservation rate was 55.2% (16/29) (grade A+B hearing). Among them, a hearing for 7 cases of 43.8% (7/16), B grade 9 cases 56.3% (9/16) before operation. 鍚�鍔涗负A绾х殑鎮ｈ，

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