围脑干肿瘤61例临床分析

发布时间：2018-03-11 18:42

本文选题：围脑干肿瘤　切入点：核磁共振　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析围脑干肿瘤的临床症状体征、核磁共振影像学表现、手术入路方式、相关并发症术后对策及预后。方法回顾分析本院神经外科2013年3月至2016年5月经显微外科手术治疗的61例围脑干肿瘤病人的相关临床资料,从肿瘤对脑干的不同受压部位所出现的症状体征、核磁共振影像学表现、手术入路方式、相关并发症术后对策及预后予以总结分析。结果脑干功能十分重要,围脑干肿瘤的临床特点复杂多样,头痛、锥体束征和脑神经功能损害等症状较术前明显缓解;影像学检查能够确定肿瘤从不同角度压迫脑干的程度、手术入路的选择。显微镜下肿瘤全部切除42例(68.8%),次全切除12例(19.7%),大部分切除7例(11.5%),死亡3例(4.9%)。病理检查结果:13例神经鞘瘤,8例髓母细胞瘤,8例室管膜瘤,7例脑膜瘤,5例血管母细胞瘤,4例表皮样囊肿,4例星形细胞瘤,3例颅咽管瘤,3例海绵状血管瘤,2例胶质母细胞瘤,2例巨大垂体瘤,1例转移癌,1例生殖细胞瘤;术后主要并发症:10例高热,1例中枢性呼吸困难,4例癫痫,1例昏迷,15例吞咽困难,4例面瘫,4例听力下降,19例肢体无力,7例复视,13例肺部感染,2例小脑缄默症,6例颅内感染,5例应激性溃疡,3例头皮下积液,12例脑积水,5例硬膜下积液,1例脑出血。术后在专业医师指导下进行病变神经康复功能锻炼,大部分病人症状得到改善。经过3-6个月随访,对患者生活质量进行评估,应用Barthel指数评定量表,45例60分以上,9例40-60分,4例20-40分。60分以上的为预后良好,60分下的为预后不良。结论围脑干肿瘤的临床症状以脑神经功能损伤为主,并发症多而复杂。核磁共振影像学检查对围脑干肿瘤的诊断、定位及治疗方面重要意义。手术入路应考虑肿瘤的位置、大小、血供、压迫脑干的方向,在尽量全切肿瘤的情况下,避免神经牵拉及损伤。围脑干肿瘤术后并发症较严重,致残率高,部分预后良好,提高手术质量是关键,积极处理和预防并发症对改善患者预后有很大的作用,经随访发现术后出现脑积水的患者预后差。
[Abstract]:Objective to analyze the clinical symptoms and signs, MRI findings and operative approach of brain stem tumors. Methods the clinical data of 61 patients with peribrainstem tumors treated by microsurgery from March 2013 to 2016 were retrospectively analyzed. The symptoms and signs of tumor in different compression sites of brain stem, MRI findings, operative approach, postoperative complications and prognosis were summarized and analyzed. Results brain stem function is very important. The clinical features of brain stem tumors are complicated and varied, headache, pyramidal beam sign and brain nerve function damage are more relieved than those before operation, and imaging examination can determine the degree of compression of brain stem from different angles. Selection of operative approach. Total resection of tumors under microscope was performed in 42 cases (68.8%), subtotal resection in 12 cases (19.7%), major resection in 7 cases (11. 5%), death in 3 cases (4. 9%). Pathological examination of 13 cases of schwannoma, 8 cases of medulloblastoma, 8 cases of ependymoma, 7 cases of ependymoma. 5 cases of hemangioblastoma 4 cases of epidermoid cyst 4 cases of astrocytoma 3 cases of craniopharyngioma 3 cases of cavernous hemangioma 2 cases of glioblastoma 2 cases of giant pituitary tumor 1 case of metastatic carcinoma 1 case of germ cell tumor; Major postoperative complications: 10 cases of hyperpyrexia 1 case of central dyspnea 4 cases of epilepsy and 1 case of coma 15 cases of dysphagia 4 cases of facial paralysis 4 cases of hearing loss 7 cases of limb weakness 7 cases of diplopia 13 cases of pulmonary infection 2 cases of cerebellar mutism 6 cases of cranium. There were 5 cases of stress ulcer and 3 cases of hydrocephalus 12 cases of hydrocephalus 5 cases of subdural effusion and 1 case of cerebral hemorrhage. Most of the patients' symptoms improved. After 3-6 months follow-up, the quality of life of the patients was evaluated. The Barthel index was used to evaluate 45 cases with more than 60 points, 9 cases with 40-60 scores and 4 cases with 20-40 scores. The prognosis of the patients with the scores above 60 was good and the prognosis with the score above 60 was poor. Conclusion the clinical symptoms of peribrainstem tumors are mainly brain nerve function damage. The complications are numerous and complicated. Magnetic resonance imaging is of great significance in the diagnosis, localization and treatment of peribrainstem tumors. The location, size, blood supply and direction of compression of the brain stem should be taken into account in the operative approach. In the case of total resection of tumor, nerve traction and injury should be avoided. The complications of brain stem tumor after operation are serious, the rate of disability is high, and some prognosis is good. Improving the quality of operation is the key. Active management and prevention of complications have great effect on improving the prognosis of patients with hydrocephalus after follow-up found that the prognosis of patients with hydrocephalus is poor.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41

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