本文選題：頸椎椎體病變 + 內鏡��； 參考：《山東大學》2017年博士論文

【摘要】：研究背景臨床上頸椎椎體腫瘤比較少見,多發(fā)病隱匿,而且早期癥狀沒有特異性,故患者早期無明顯臨床癥狀,常被誤認為頸椎病而延誤到出現(xiàn)脊髓壓迫癥狀時才來就診。Levine等報道一組9例頸椎腫瘤中,95%的患者有局限性疼痛,37%的頸椎良性腫瘤伴有根性痛�；颊咧�29%出現(xiàn)斜頸,14%出現(xiàn)感覺障礙,7%出現(xiàn)局限性運動障礙。目前國內外認為手術是頸椎椎體腫瘤最重要、最有效的治療方法。傳統(tǒng)的頸椎椎體腫瘤手術方式主要有三種:前路手術、后路手術及前后聯(lián)合手術,其存在手術徑路遠、創(chuàng)傷大、有損傷頸部重要血管神經引發(fā)嚴重并發(fā)癥可能,尤其是兒童頸椎惡性腫瘤手術難度大、易復發(fā),預后差,如何安全有效地暴露并切除頸椎椎體病變是臨床醫(yī)師正在探討中的課題,近年來以安全、可靠且創(chuàng)傷小的微創(chuàng)方法治療頸椎椎體病變逐漸應用于臨床。隨著鼻內鏡解剖、內鏡技術和顱底外科學的發(fā)展,進一步擴大了鼻內鏡外科手術的治療范圍。目前國內外有關鼻內鏡下口內徑路對頸椎椎體腫瘤施行手術切除尚未有文獻報道。受學者們切除脊索瘤和齒狀突病變的啟發(fā),我們對20例新鮮尸頭標本,進行寰樞椎CT測量,獲得詳細的解剖學數(shù)據(jù),對10例新鮮灌注尸頭標本,采用內鏡下口內徑路對頸椎椎體及相關區(qū)域行模擬手術并解剖學觀測。臨床上采用內鏡下經口徑路對8例頸椎椎體良性病變施行手術切除,主要論述了頸椎椎體良性病變內鏡下口內徑路切除術的手術特點、術中操作技巧以及術中、術后并發(fā)癥的預防等,探索頸椎椎體良性病變內鏡下口內徑路手術切除的可行性。目的探索頸椎椎體良性病變內鏡下口內徑路手術切除的可行性及臨床驗證。資料和方法對20例新鮮尸頭標本,進行寰樞椎CT測量,獲得詳細的解剖學數(shù)據(jù),包括寰椎前弓長度、寰椎前結節(jié)厚度、寰椎側塊橫徑、寰椎側塊矢狀徑、寰樞椎兩側橫突孔內側間距、寰樞椎兩側橫突孔外側間距等;對10例新鮮灌注尸頭標本,采用內鏡下口內徑路對頸椎椎體及相關區(qū)域行模擬手術并解剖學觀測,以期為臨床提供較為詳實的解剖學資料。2013年10月-2015年10月,在深圳市第二人民醫(yī)院耳鼻咽喉科住院部,我們采用鼻內鏡系統(tǒng)、經口內徑路切除8例頸椎椎體良性病變,男5例、女3例;年齡5歲-42歲,平均20歲;臨床表現(xiàn)為頸痛6例,頭痛2例,頭部不穩(wěn)感2例,頸部活動受限2例,頸部活動不適1例。嗜酸性肉芽腫7例、脂肪瘤1例。所有患者均在手術前、后行頸椎電子計算機斷層掃描(Computed tomography,CT)加增強軸位、冠狀位和矢狀位檢查,頸椎磁共振成像(Magnetic resonance imaging,MRI)檢查,以確定病變位置、范圍及與周圍結構的關系。8例患者中5例侵犯寰樞椎椎體,3例侵犯第三頸椎椎體,均未侵及硬脊膜和脊髓。5例患者術前行三維(Three dimensional,3D)重建并3D打印模型,為術前治療方案設計及與患者家屬溝通提供了幫助。所有患者術前均已簽署手術知情同意書。結果新鮮尸頭寰樞椎CT測量值:寰椎前弓長度(19.6±2.6)mm,寰椎前結節(jié)厚度(8.1 ±0.7)mm,寰椎側塊橫徑(左)(12.8±2.6)MmMm,寰椎側塊橫徑(右)(12.8±1.9)mm,寰椎側塊矢狀徑(左)(14.9±2.4)mm,寰椎側塊矢狀徑(右)(15.2 ±1.6)mm,寰椎兩側橫突孔內側間距(47.1±1.5)mm,寰椎兩側橫突孔外側間距(60.6± 1.6)mm,樞椎兩側橫突孔內側間距(29.1 ±1.5)mm,樞椎兩側橫突孔外側間距(44.2士 1.8)mm。灌注尸頭標本模擬手術結果:①內鏡下口徑路可顯露寰樞椎腹側,包括:寰椎、樞椎椎體,寰椎前弓、側塊,齒突及兩側椎動脈;②上方常規(guī)可顯露至寰椎前弓上緣或斜坡下部,下方可顯露至C2/3椎間盤或C3椎體上部,兩側安全邊界可界定:寰椎層面為寰樞側塊關節(jié)外緣,樞椎層面為樞椎體外緣�？蓾M足內鏡口內徑路手術需要。8例臨床患者病變均一次徹底切除,未見明顯并發(fā)癥發(fā)生;術后8小時經口進食;手術當天全麻清醒后至術后第3天采用NRS評分法評估疼痛程度,平均2.25分;術后5天拆線并出院,平均住院時間6.5天;平均住院費用8225元。隨訪3-12個月。8例患者均于術后3月行頸椎CT檢查,腫物均被完整切除,無復發(fā)。結論內鏡口內徑路頸椎椎體良性病變切除術對頸部椎體病變暴露清楚,此徑路具有徑路短、技術簡單、療效可靠、并發(fā)癥少、手術時間短、術后恢復快等優(yōu)點,值得推廣。
[Abstract]:Background clinical cervical vertebra tumor is rare, frequently occult, and the early symptoms are not specific, so the patients have no obvious clinical symptoms in the early stage, and are often mistaken for cervical spondylosis to be delayed to the symptoms of spinal cord compression to report.Levine and other 9 cervical tumors, 95% of the patients have localized pain, and 37% of the cervical spine. Benign tumors are associated with root pain. 29% of the patients have torticollis, 14% have sensory disorders, and 7% have localized dyskinesia. At present, surgery is considered the most important and most effective method for cervical vertebra tumor. There are three methods of the traditional cervical vertebra tumor operation: anterior, posterior and combined surgery. The surgical path is far, the trauma is large and the serious complications of the important cervical vessels and nerves may be damaged. Especially, the operation of the cervical malignant tumor in children is difficult, easy to recur, and the prognosis is poor. How to expose and Excise cervical vertebra vertebral lesions safely and effectively is a subject being discussed by the clinicians. In recent years, the minimally invasive and safe side is safe, reliable and minimally invasive. The treatment of cervical vertebra vertebral lesions is gradually applied to clinical. With the development of endoscopic anatomy, endoscopic technique and skull base surgery, the scope of treatment for endoscopic surgery has been further expanded. With the elicitation of odontoid process, 20 cases of fresh cadaver head specimens were measured by CT, and detailed anatomical data were obtained. 10 cases of fresh perfusion head specimens were used to simulate the cervical vertebra and related areas by endoscopy. On the bed, 8 cases of cervical vertebra were treated by endoscopy. Surgical resection of sexual lesions was performed. The characteristics of endoscopic surgical resection of the cervical vertebra benign lesions, operation skills and prevention of postoperative complications were discussed. The feasibility of endoscopic surgical resection under endoscopy for cervical vertebral benign lesions was explored. The feasibility and clinical validation of surgical resection of the path. Data and methods were used to measure the atlantoaxial CT and obtain detailed anatomical data, including the length of the anterior arch of the atlas, the thickness of the anterior atlas, the lateral diameter of the atlas, the sagittal diameter of the atlas lateral mass, the inner space of the lateral transverse foramen of the atlantoaxial, and the lateral lateral transverse foramen of the atlantoaxial. In order to provide more detailed anatomical data of the cervical vertebra and related areas, 10 cases of fresh perfused cadaver head specimens were used to provide more detailed anatomical data of the cervical vertebra and related areas by endoscopy in order to provide more detailed anatomical data in the hospital department of the Department of Otolaryngology, Shenzhen No.2 People's Hospital, in October,.2013, October. We used the nasal endoscopy system. 8 cases of benign cervical vertebral lesions, 5 male and 3 female, aged 5 years -42 years old, with an average of 20 years of age, 6 cases of cervical pain, 2 headache, 2 head instability, 2 neck movement, 1 cervical motion discomfort, 7 eosinophilic granuloma and 1 cases of lipoma. All the patients were scanned by CT scan before operation. (Computed tomography, CT) plus axial, coronal and sagittal examination, cervical magnetic resonance imaging (Magnetic resonance imaging, MRI) examination to determine the location, range and relation to the surrounding structure in 5 cases of.8 patients who had infringed the atlantoaxial vertebral body and 3 cases of the third cervical vertebrae, both of which were not invaded by the spinal cord and spinal cord before operation. The Three dimensional (3D) reconstruction and 3D print model were used to provide help for the preoperative treatment scheme design and communication with the patient's family. All patients had signed the operation informed consent before operation. Results fresh cadaver head atlantoaxial CT measurements: the anterior atlas arch length (19.6 + 2.6) mm, the thickness of the anterior atlas (8.1 + 0.7) mm, and the lateral mass of the atlas ( Left) (12.8 + 2.6) MmMm, lateral mass of atlas (right) (12.8 + 1.9) mm, lateral mass of atlas (14.9 + 2.4) mm, sagittal diameter of atlas (15.2 + 1.6) mm, medial space distance (47.1 + 1.5) mm on the lateral transverse foramen of atlas (47.1 + 1.5) mm, lateral space between the lateral transverse foramen of atlas (29.1 + 12.8) mm, and lateral transverse process of the axis The surgical results of the cadaver head specimens of the lateral spaced space (44.2 st 1.8) mm. were simulated: (1) the endoscopic aperture route revealed the atlantoaxial ventral side, including the atlas, the axis of the axis, the anterior arch of the atlas, the lateral mass, the odontoid and the bilateral vertebral arteries; the above routine could be exposed to the upper or lower part of the anterior arch of the atlas or the lower part of the slope, and the lower part could be exposed to the upper part of the intervertebral disc or the C3 vertebral body, two The side safety boundary can be defined as the outer edge of the atlantoaxial side, the axis of the axis is the outer edge of the axis of the axis. It can satisfy the endoscopic surgery in.8 patients with a complete resection and no obvious complications. 8 hours after the operation, the operation is taken after the operation of the general anesthesia and the third day after the operation by the NRS score. The degree of pain was estimated at an average of 2.25 points, 5 days after operation and discharge, the average hospitalization time was 6.5 days, and the average hospitalization cost was 8225 yuan. All patients were followed up for 3-12 months and.8 patients were examined by cervical CT in March. All the tumors were completely removed and no recurrence was found. The path has the advantages of short path, simple technique, reliable curative effect, few complications, short operation time and quick postoperative recovery, and is worthy of promotion.
【學位授予單位】：山東大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R687.3;R322.7

【參考文獻】

相關期刊論文 前10條

1 余勇;胡凡;張曉彪;葛俊琦;顧燁;謝濤;王學建;姜曉幸;蔣淳;;導航內鏡下經鼻齒狀突切除術治療顱底凹陷畸形[J];中國現(xiàn)代神經疾病雜志;2012年04期

2 萬勇;梁堂釗;鄭召民;彭新生;陳立言;劉少喻;;兒童頸椎腫瘤外科治療[J];中山大學學報(醫(yī)學科學版);2009年S4期

3 胡建中;徐大啟;蔣衛(wèi)紅;王錫陽;張宏其;黃躍平;;枕頸融合聯(lián)合鼻內鏡治療樞椎腫瘤[J];脊柱外科雜志;2007年05期

4 蔡維山;徐中和;郭東明;鐘波夫;劉恩志;;頸椎腫瘤的手術切除和穩(wěn)定性重建[J];廣東醫(yī)學;2007年03期

5 張朝躍;苗驚雷;吳松;詹瑞森;;內鏡下經口咽入路寰樞椎手術的基礎與臨床研究[J];中國內鏡雜志;2006年10期

6 林斌;郭林新;丁真奇;練克儉;郭延杰;郭志民;劉慶軍;;一期前后聯(lián)合入路上頸椎全切除術治療上頸椎腫瘤[J];臨床骨科雜志;2006年05期

7 尹慶水;權日;何帆;艾福志;麥小紅;;一期經口前路腫瘤切除和前后路椎體重建治療樞椎骨巨細胞瘤[J];中國脊柱脊髓雜志;2006年01期

8 肖建如,賈連順;脊柱轉移性腫瘤的外科治療策略[J];中華骨科雜志;2003年01期

9 肖建如,賈連順,袁文,陳德玉,倪斌,趙定麟;頸椎原發(fā)性骨腫瘤的外科分期及其手術治療[J];中華骨科雜志;2001年11期

10 保建基,張志強,宋來君,龍江;擴大經口入路切除顱底硬膜外腫瘤[J];中國神經精神疾病雜志;2001年04期

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