【摘要】：目的：探討鎖孔微創(chuàng)手術(shù)治療第三腦室腫瘤的個體化入路設(shè)計及臨床療效 方法：對蘇州大學附屬第二醫(yī)院從2000年8月至2013年8月收治的64例第三腦室腫瘤患者，根據(jù)病灶特點及生長方式，分別設(shè)計經(jīng)眉弓眶上額下鎖孔入路、天幕下小腦上鎖孔入路、縱裂胼胝體鎖孔入路、翼點鎖孔入路及枕部鎖孔入路，從前方、后方、上方或側(cè)方進入第三腦室切除腫瘤。術(shù)中切除腫瘤后打通腦脊液循環(huán)通路，確保第三腦室腦脊液循環(huán)通暢。 結(jié)果：腫瘤全切51例（79.69%），，次全切13例（20.31%）；無手術(shù)死亡病例，無因術(shù)中病情變化或暴露不良而擴大切口及骨瓣的病例；前方鎖孔入路尿崩及視力視野惡化的發(fā)生率均為8.70%（4/46）、幕下小腦上鎖孔入路小腦腫脹的發(fā)生率為7.69%（1/13），所有鎖孔入路術(shù)后出血、顱內(nèi)感染、意識障礙、腦脊液切口漏的發(fā)生率分別為：3.13%、3.13%、1.56%、1.56%；無癲癇以及牽拉腦組織導致的腦挫傷等并發(fā)癥；術(shù)前37例有腦積水者36例術(shù)后均好轉(zhuǎn)或消失，僅1例術(shù)后2月因交通性腦積水行腰大池-腹腔腦脊液分流術(shù)。 結(jié)論： 1、鎖孔微創(chuàng)手術(shù)是治療第三腦室腫瘤的有效辦法，能安全、微創(chuàng)地切除腫瘤，并一期解除腦脊液循環(huán)通路的梗阻。 2、設(shè)計個體化的鎖孔入路是第三腦室腫瘤手術(shù)成功的保障：縱裂胼胝體鎖孔入路適合于第三腦室中上部腫瘤手術(shù)；天幕下小腦上鎖孔入路適合于第三腦室后部腫瘤手術(shù)；枕部鎖孔入路適合于第三腦室側(cè)方生長的腫瘤手術(shù)；經(jīng)眉弓眶上額下鎖孔入路、翼點鎖孔入路適合于第三腦室前部腫瘤手術(shù)，而經(jīng)眉弓眶上額下鎖孔入路可更縱深方向顯露第三腦室。
[Abstract]:Objective: to investigate the design and clinical efficacy of keyhole minimally invasive approach for the treatment of third ventricular tumors. Methods: 64 patients with third ventricle tumors were treated in the second affiliated Hospital of Suzhou University from August 2000 to August 2013. According to the characteristics of the lesions and the growth pattern, the transorbital subfrontal keyhole approach, the supracerebellar keyhole approach, the corpus callosum keyhole approach, the pterional keyhole approach and the occipital keyhole approach were designed respectively. The tumor is removed by entering the third ventricle on the top or side. The cerebrospinal fluid (CSF) circulation pathway was opened after tumor resection to ensure the smooth circulation of cerebrospinal fluid (CSF) in the third ventricle. Results: there were 51 cases (79.69%) with total tumor resection and 13 cases (20.31%) with subtotal resection. The incidence of anterior keyhole approach and visual field deterioration were 8.70% (4 / 46), 7.69% (1 / 13) and 7.69% (1 / 13), respectively. The incidence of cerebrospinal fluid incision leakage was 1.56% and 1.56%, respectively; there were no complications such as epilepsy and brain contusion caused by pulling brain tissue, and 36 cases with hydrocephalus were improved or disappeared after operation. Only 1 case underwent lumbar cistern-celiac cerebrospinal fluid shunt 2 months after operation because of communicating hydrocephalus. Conclusion: 1. Keyhole minimally invasive surgery is an effective method for the treatment of tumors of the third ventricle, which can be safely and minimally invasive. At one stage, the obstruction of cerebrospinal fluid circulation pathway was relieved. 2. The design of individualized keyhole approach was the guarantee for the successful operation of the third ventricle tumor: the keyhole approach of the corpus callosum was suitable for the operation of the tumors in the middle and upper part of the third ventricle; The supratentorial keyhole approach is suitable for the surgery of posterior third ventricle neoplasms; the occipital keyhole approach is suitable for tumor surgery on the lateral side of the third ventricle; The pterygoid keyhole approach is suitable for the operation of anterior third ventricle tumor, and the supraorbital subfrontal keyhole approach can expose the third ventricle in the deeper direction.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R739.41

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