發(fā)布時間：2018-08-17 13:46

【摘要】：目的：通過對SRMs（Sphenoid ridge meningiomas,蝶骨嵴腦膜瘤）患者的診斷、治療及預(yù)后恢復(fù)情況的臨床分析，總結(jié)我們在臨床實踐中獲得的一些治療心得，探討手術(shù)操作技巧和預(yù)防并發(fā)癥要點，以期進一步提高腫瘤全切率，減少術(shù)后并發(fā)癥的發(fā)生，提高手術(shù)療效。 方法：回顧性分析我科2008年-2014年行手術(shù)治療的41例SRMs（Sphenoid ridge meningiomas,蝶骨嵴腦膜瘤）患者的臨床病例資料，依據(jù)腫瘤在蝶骨嵴處的生長位置，可將其分為內(nèi)側(cè)型SRMs和外側(cè)型SRMs兩種類型，本組包括內(nèi)側(cè)型25例和外側(cè)型16例。按照影像學(xué)上腫瘤直徑的大小，又可將蝶骨嵴腦膜瘤分為巨大型（d7cm）、大型(d為4.5-7cm)和小型(d4.5cm)三種類型，分別為3例、28例和10例。術(shù)前病人均行CT、MRI或血管造影檢查，評估病人的一般情況，提請科內(nèi)討論，通過影像學(xué)資料仔細分析蝶骨嵴腦膜瘤的生長特點，總結(jié)手術(shù)操作要點和合理預(yù)測預(yù)后情況。41例患者均采用經(jīng)翼點入路或改良翼點入路的顯微外科手術(shù)治療，術(shù)后總結(jié)腫瘤切除的程度、術(shù)后并發(fā)癥的出現(xiàn)及術(shù)后恢復(fù)情況。 結(jié)果：我們對所有患者按照Simpson分級法評估術(shù)后腫瘤切除的程度，Simpson I級切除19例，Simpson II級切除15例，Simpson III級切除5例，SimpsonⅣ切除2例。16例外側(cè)型蝶骨嵴腦膜瘤患者均行Simpson I、II級切除，其中14例行I級切除，2例行II級切除，術(shù)后未見明顯并發(fā)癥發(fā)生。25例內(nèi)側(cè)型蝶骨嵴腦膜瘤患者中，其中23例均行Simpson I、II及III級切除，1例因腫瘤與頸內(nèi)動脈和視神經(jīng)粘連緊密，1例侵入海綿竇并與其內(nèi)動眼神經(jīng)粘連較重，均行SimpsonⅣ級切除。術(shù)前30例病人出現(xiàn)顱內(nèi)壓增高，16例視力和/或視野障礙（其中2例失明），7例病側(cè)單眼突出，7例病灶對側(cè)肢體肌力下降或癱瘓，1例嗅覺障礙，3例出現(xiàn)海綿竇綜合征（主要為動眼神經(jīng)損傷），3例癲癇發(fā)作，術(shù)后除外2例失明和1例海綿竇綜合征病人無緩解或緩解不明顯，病人余癥狀均有不同程度的恢復(fù)；術(shù)后出現(xiàn)并發(fā)癥有視神經(jīng)損傷2例、面神經(jīng)顳支損傷1例、動眼神經(jīng)損傷1例、腦梗死1例和下丘腦損傷1例，均給予積極對癥處置；無死亡病例。術(shù)后隨訪0.5年至3年，，平均隨訪時間為1.5年，2例復(fù)發(fā)，無死亡。 結(jié)論：在SRMs的手術(shù)治療中，術(shù)前對臨床表現(xiàn)及影像學(xué)資料全面詳細的綜合評估，制定個體化的治療方案，選擇合適的手術(shù)入路，以扎實的顱底解剖學(xué)為基礎(chǔ)，結(jié)合術(shù)中嫻熟的顯微手術(shù)操作技巧，可最大程度的切除腫瘤和顯著降低術(shù)后并發(fā)癥的發(fā)生，對患者的預(yù)后意義重大。
[Abstract]:Objective: to analyze the diagnosis, treatment and prognosis of SRMs (Sphenoid ridge meningiomas, patients with sphenoid ridge meningioma. In order to further improve the total tumor resection rate, reduce the incidence of postoperative complications, improve the effectiveness of surgery. Methods: the clinical data of 41 cases of SRMs (Sphenoid ridge meningiomas, sphenoid ridge meningioma treated in our department from 2008 to 2014 were retrospectively analyzed. According to the location of the tumor at the sphenoid ridge, it could be classified into medial type SRMs and lateral type SRMs. There were 25 cases of medial type and 16 cases of lateral type. According to the diameter of the tumor on imaging, the sphenoid ridge meningioma can be divided into three types: giant (d7cm), large (d: 4.5-7cm) and small (d4.5cm), which are 28 cases and 10 cases, respectively. All patients were examined by CT MRI or angiography before operation. The general situation of the patients was evaluated and discussed by Kone. The growth characteristics of sphenoid ridge meningioma were carefully analyzed by imaging data. All 41 patients were treated by microsurgery via pterygoid approach or modified pterygoid approach. The degree of tumor resection, the occurrence of postoperative complications and the postoperative recovery were summarized. Results: according to the Simpson grade method, we evaluated the degree of tumor resection in all patients. All the patients were treated with Simpson II grade II resection in 19 cases with III grade 鈪

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