本文選題：頸靜脈孔 + 腫瘤�。� 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究目的:探討各種不同病理類型的頸靜脈孔區(qū)腫瘤的臨床特征、影像學(xué)特征、手術(shù)治療策略、治療效果、預(yù)后及預(yù)后不良的相關(guān)危險因素。研究方法:對山東省立醫(yī)院西院2005年9月至2016年4月就診的72例頸靜脈孔區(qū)腫瘤患者的臨床資料、隨訪信息進行回顧性分析。所有患者術(shù)前均行頸靜脈孔區(qū)的影像學(xué)檢查,包括CT、MRI、CTA檢查,并根據(jù)情況選擇血管造影和腫瘤供血血管栓塞。采用顯微外科技術(shù)切除腫瘤,術(shù)后隨訪10～137個月。統(tǒng)計分析腫瘤的臨床特點、影像學(xué)特點、病理分型、腫瘤分期,手術(shù)治療效果,不同手術(shù)入路的應(yīng)用及預(yù)后等;分別分析不同類型頸靜脈孔區(qū)腫瘤的復(fù)發(fā)率;Logistic回歸分析不同因素與腫瘤預(yù)后的相關(guān)性,涉及的危險因素包括腫瘤分期、病理類型、手術(shù)切除范圍、術(shù)前出現(xiàn)面癱、后組顱神經(jīng)受損癥狀、年齡等。結(jié)果:72例臨床資料中,就診年齡為22-84歲,平均年齡46.7歲。女性多于男性,男性35名,女性37名。隨訪時間為61.32 ± 39.02個月(10～137個月),主要臨床癥狀搏動性搏動性耳鳴48.6%,聽力下降62.5%,周圍性面癱占37.5%,頸部腫塊占6.9%,后組顱神經(jīng)癥狀聲嘶20.80%;嗆咳20.8%;伸舌偏22.2%,軟腭麻痹19.4%,聳肩無力8.3%,頭疼占13.9%,平衡障礙占19.4%,外耳道溢液占20.8%,耳痛16.7%。本組72例腫瘤分類均為FISCH分型C級以上。其中66例行經(jīng)顳下窩A入路頸靜脈孔區(qū)腫瘤切除術(shù),2例行顳下窩A入路聯(lián)合迷路后入路,3例行顳下窩A入路聯(lián)合乙狀竇后入路,1例行顳下窩A入路聯(lián)合經(jīng)迷路入路腫瘤切除。60例全切除,12例次全切除,本組腫瘤的全切率為83.32%(60/72)。病理結(jié)果顯示頸靜脈副節(jié)瘤31例,占43.1%;神經(jīng)鞘瘤12例,占16.7%;腦膜瘤4例,占5.6%,其中包括1例側(cè)顱底異位間變腦膜瘤,1例頸靜脈孔及右鼓室腦膜瘤;軟骨肉瘤5例,占6.9%;內(nèi)淋巴囊腺腫瘤4例,占5.6%;神經(jīng)纖維瘤4例,占5.6%;鱗癌2例,占2.8%,其中1例伴乳突膽脂瘤;腺癌4例,占5.6%;巨細胞瘤1例,占1.4%;漿細胞瘤1例,占1.4%;惡性副節(jié)瘤2例,占2.8%;骨母細胞瘤1例,占1.4%;骨纖維結(jié)構(gòu)異常1例,占1.4%;神經(jīng)纖維瘤圍手術(shù)期死亡1人。術(shù)后患者可出現(xiàn)聽力喪失、面癱、后組顱神經(jīng)癥狀,但根據(jù)情況不同可逐漸緩解,副節(jié)瘤患者術(shù)后搏動性耳鳴多緩解。31例副節(jié)瘤總復(fù)發(fā)率為13.0%,全切復(fù)發(fā)率為9.5%,次全切復(fù)發(fā)率為50%,12例神經(jīng)鞘瘤總復(fù)發(fā)率為8.3%,全切復(fù)發(fā)率為0,次全切復(fù)發(fā)率為33.3%;7例患者死亡,包括鱗癌2例,腺癌1例,漿細胞瘤1例,惡性副節(jié)瘤1例,間變腦膜瘤1例,神經(jīng)纖維瘤1例術(shù)后猝死。就診時已出現(xiàn)面癱、后組顱神經(jīng)癥狀,病理惡性程度越高,手術(shù)切除不完全增加了患者的復(fù)發(fā)率(*P0.05)。結(jié)論:1.頸靜脈孔區(qū)腫瘤中頸靜脈副節(jié)瘤、神經(jīng)鞘瘤比較多見,又存在各種特殊的病理類型。2.規(guī)范的術(shù)前評估十分重要,對于確定正確的手術(shù)入路具有重要意義。3.顳下窩A入路腫瘤切除術(shù),可以滿足大多數(shù)頸靜脈孔區(qū)腫瘤切除的要求。根據(jù)病變范圍可聯(lián)合迷路后,乙狀竇后入路手術(shù)。4.不同病理類型腫瘤影像學(xué)特征可有其特異性表現(xiàn),具有鑒別診斷價值。5.病理類型為惡性、后組顱神經(jīng)受累、面神經(jīng)受累、手術(shù)切除不完全為術(shù)后復(fù)發(fā)、預(yù)后不良的可能危險因素。
[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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.91

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