【摘要】：[目的]探討經(jīng)小腦延髓裂入路切除第四腦室腫瘤的相關(guān)注意事項,及術(shù)后并發(fā)癥的防治,以提高手術(shù)效果。[方法]回顧性分析昆明醫(yī)科大學(xué)第一附屬醫(yī)院2013年1月～2017年2月20例經(jīng)手術(shù)治療第四腦室腫瘤患者的臨床資料,均采取枕下后正中開顱,經(jīng)小腦延髓裂入路切除第四腦室腫瘤,術(shù)后觀察患者腫瘤切除率、枕后皮下積液和小腦緘默癥等并發(fā)癥的發(fā)生情況及6個月后主要癥狀、體征及并發(fā)癥的恢復(fù)情況。[結(jié)果]本組全切除病變15例(75.0%),次全切除5例(25.0%),無手術(shù)死亡病例。術(shù)后病理診斷髓母細(xì)胞瘤5例,血管母細(xì)胞瘤、脈絡(luò)叢乳頭狀瘤及星型細(xì)胞膠質(zhì)瘤各3例,海綿狀血管瘤及室管膜瘤各2例,表皮樣囊腫及腦膜瘤各1例。術(shù)后并發(fā)癥:癥狀性腦積水5例,行腦室-腹腔分流術(shù);上消化道出血2例,顱神經(jīng)功能障礙2例,顱內(nèi)積氣4例,顱內(nèi)感染2例,均經(jīng)保守治療后痊愈。本組無枕后皮下積液病例及小腦緘默癥。術(shù)后頭暈、頭痛及步態(tài)不穩(wěn)等均有明顯改善。術(shù)后6個月卡氏功能狀態(tài)標(biāo)準(zhǔn)評分:100分1例,90分3例,80分10例,70分5例,60分1例。20例患者術(shù)后隨訪10-33個月,20例均能生活正常,3例復(fù)發(fā)(其中1例死亡)。[結(jié)論]小腦延髓裂入路通過分離脈絡(luò)膜及下髓帆,可清楚地顯露腦室側(cè)壁、閂部及中腦導(dǎo)水管下口,不損傷任何腦組織,且術(shù)后小腦緘默綜合征等并發(fā)癥發(fā)生率低。因此,經(jīng)小腦延髓裂入路切除第四腦室腫瘤是安全、有效的方法。
[Abstract]:[objective] to explore the related matters needing attention and the prevention and treatment of postoperative complications in the resection of fourth ventricle tumor via the approach of medullary fissure of cerebellar oblongata, in order to improve the effect of operation. [methods] the clinical data of 20 patients with fourth ventricle tumor treated surgically from January 2013 to February 2017 in the first affiliated Hospital of Kunming Medical University were retrospectively analyzed. The fourth ventricle tumor was resected via the cerebellar medullary fissure approach. The rate of tumor resection, the occurrence of complications such as subcutaneous effusion of the occipital and cerebellar mutism, and the recovery of the main symptoms, signs and complications after 6 months were observed. [results] there were 15 cases (75.0%) with total resection and 5 cases (25.0%) with subtotal resection. Pathological findings included myeloblastoma (n = 5), hemangioblastoma (n = 3), choroid plexus papilloma (n = 3) and astrocytoma (n = 3), cavernous hemangioma and ependymoma (n = 2), epidermoid cyst (n = 1) and meningioma (n = 1). Postoperative complications included symptomatic hydrocephalus (5 cases), ventriculoperitoneal shunt (VCP), upper gastrointestinal hemorrhage (2 cases), cranial nerve dysfunction (2 cases), intracranial gas accumulation (4 cases) and intracranial infection (2 cases). There was no posterior occipital subcutaneous effusion and cerebellar mutism. Postoperative dizziness, headache and gait instability were significantly improved. Six months after operation, the standard score of Karnox functional status was 100 in 1 case, 90 in 3, 80 in 10, 70 in 5, and 60 in 1. 20 patients were followed up for 10-33 months, 20 cases were normal and 3 cases recurred (1 case died). [conclusion] by separating choroid and inferior medullary sail, the cerebellar medullary fissure approach can clearly expose the lateral wall of the ventricle, the latch and the inferior orifice of the aqueduct of the midbrain without any injury to any brain tissue, and the incidence of complications such as cerebellar mutism syndrome is low after operation. Therefore, transcerebellar medullary fissure approach is a safe and effective method for resection of fourth ventricle tumors.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.41

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