小脑延髓裂入路切除第四脑室肿瘤的临床应用及术后并发症防治

发布时间：2018-12-20 08:11

【摘要】：[目的]探讨经小脑延髓裂入路切除第四脑室肿瘤的相关注意事项,及术后并发症的防治,以提高手术效果。[方法]回顾性分析昆明医科大学第一附属医院2013年1月～2017年2月20例经手术治疗第四脑室肿瘤患者的临床资料,均采取枕下后正中开颅,经小脑延髓裂入路切除第四脑室肿瘤,术后观察患者肿瘤切除率、枕后皮下积液和小脑缄默症等并发症的发生情况及6个月后主要症状、体征及并发症的恢复情况。[结果]本组全切除病变15例(75.0%),次全切除5例(25.0%),无手术死亡病例。术后病理诊断髓母细胞瘤5例,血管母细胞瘤、脉络丛乳头状瘤及星型细胞胶质瘤各3例,海绵状血管瘤及室管膜瘤各2例,表皮样囊肿及脑膜瘤各1例。术后并发症:症状性脑积水5例,行脑室-腹腔分流术;上消化道出血2例,颅神经功能障碍2例,颅内积气4例,颅内感染2例,均经保守治疗后痊愈。本组无枕后皮下积液病例及小脑缄默症。术后头晕、头痛及步态不稳等均有明显改善。术后6个月卡氏功能状态标准评分:100分1例,90分3例,80分10例,70分5例,60分1例。20例患者术后随访10-33个月,20例均能生活正常,3例复发(其中1例死亡)。[结论]小脑延髓裂入路通过分离脉络膜及下髓帆,可清楚地显露脑室侧壁、闩部及中脑导水管下口,不损伤任何脑组织,且术后小脑缄默综合征等并发症发生率低。因此,经小脑延髓裂入路切除第四脑室肿瘤是安全、有效的方法。
[Abstract]:[objective] to explore the related matters needing attention and the prevention and treatment of postoperative complications in the resection of fourth ventricle tumor via the approach of medullary fissure of cerebellar oblongata, in order to improve the effect of operation. [methods] the clinical data of 20 patients with fourth ventricle tumor treated surgically from January 2013 to February 2017 in the first affiliated Hospital of Kunming Medical University were retrospectively analyzed. The fourth ventricle tumor was resected via the cerebellar medullary fissure approach. The rate of tumor resection, the occurrence of complications such as subcutaneous effusion of the occipital and cerebellar mutism, and the recovery of the main symptoms, signs and complications after 6 months were observed. [results] there were 15 cases (75.0%) with total resection and 5 cases (25.0%) with subtotal resection. Pathological findings included myeloblastoma (n = 5), hemangioblastoma (n = 3), choroid plexus papilloma (n = 3) and astrocytoma (n = 3), cavernous hemangioma and ependymoma (n = 2), epidermoid cyst (n = 1) and meningioma (n = 1). Postoperative complications included symptomatic hydrocephalus (5 cases), ventriculoperitoneal shunt (VCP), upper gastrointestinal hemorrhage (2 cases), cranial nerve dysfunction (2 cases), intracranial gas accumulation (4 cases) and intracranial infection (2 cases). There was no posterior occipital subcutaneous effusion and cerebellar mutism. Postoperative dizziness, headache and gait instability were significantly improved. Six months after operation, the standard score of Karnox functional status was 100 in 1 case, 90 in 3, 80 in 10, 70 in 5, and 60 in 1. 20 patients were followed up for 10-33 months, 20 cases were normal and 3 cases recurred (1 case died). [conclusion] by separating choroid and inferior medullary sail, the cerebellar medullary fissure approach can clearly expose the lateral wall of the ventricle, the latch and the inferior orifice of the aqueduct of the midbrain without any injury to any brain tissue, and the incidence of complications such as cerebellar mutism syndrome is low after operation. Therefore, transcerebellar medullary fissure approach is a safe and effective method for resection of fourth ventricle tumors.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41

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