本文選題：小腦延髓裂入路 + 顯微解剖��； 參考：《蘭州大學(xué)》2009年碩士論文

【摘要】： 目的研究經(jīng)小腦延髓裂入路(transcerebellomedullary fissure approach)相關(guān)的顯微解剖結(jié)構(gòu)和毗鄰關(guān)系,在不切開下蚓部情況下,分離小腦延髓裂(CMF)獲得最充分的術(shù)野。切除小腦延髓裂、橋腦、第四腦室周圍占位病變。為指導(dǎo)臨床手術(shù)提供參考。 方法應(yīng)用顯微外科解剖技術(shù),對經(jīng)甲醛固定,血管乳膠灌注的5具成人濕性尸頭標(biāo)本,按不同手術(shù)入路逐層解剖,觀察相關(guān)組織和血管的形態(tài)結(jié)構(gòu)和毗鄰關(guān)系,并做了測量和統(tǒng)計分析。采用小腦延髓裂入路不同切開方法,對小腦延髓裂、四腦室周圍、及橋腦部位的占位病變20例進行手術(shù)切除,結(jié)合切開方式和預(yù)后,并對相關(guān)病變切除和顯露程度進行描述和分析,并對3例典型病例說明。 結(jié)果小腦延髓裂入路,不需切開下蚓部,可完全縱向顯露從閂至導(dǎo)水管下口,側(cè)向顯露從閂至外側(cè)孔的四腦室底及橋腦背外側(cè)區(qū)域。比較小腦下蚓部入路,小腦延髓裂入路縱向顯露距離無差別(P＞0.05),側(cè)向顯露距離明顯大于下蚓部入路(P＜0.05)。經(jīng)小腦延髓裂入路,不需切開下蚓部,可清楚暴露從導(dǎo)水管下口至閂的四腦室任何部位,通過外側(cè)隱窩至外側(cè)孔和橋腦背外側(cè)。術(shù)中廣泛型CMF切開11例,外側(cè)壁型切開7例,外側(cè)隱窩CMF切開2例。病變顯露良好者16例(80%),顯露不良和顯露困難者各2例(10%)。病變?nèi)谐?0例(50%),次全切除6例(30%),部分切除4例(20%)。出院時GOS預(yù)后評分5分者12例(60%),4分者8例(40%),無重殘或死亡。術(shù)后無新增加的神經(jīng)功能缺損癥狀。病理診斷:室管膜瘤6例,星形細胞瘤3例,髓母細胞瘤3例,海綿狀血管瘤3例,上皮樣囊腫2例,脈絡(luò)叢乳頭狀瘤、腦動靜脈畸形和血管母細胞瘤各1例。 結(jié)論小腦延髓裂入路可充分顯露CMF、第四腦室周圍、橋腦區(qū)域,比較下蚓部入路,顯露充分,神經(jīng)組織損傷小,手術(shù)安全性提高。經(jīng)小腦延髓裂正常解剖間隙到達四腦室周圍和橋腦背側(cè)方,臨床應(yīng)用該入路手術(shù)可減少神經(jīng)功能障礙和術(shù)后并發(fā)癥。
[Abstract]:Objective to study the microanatomical structure and adjacent relationship of transcerebellomedullary fissure approach through the cerebellar medulla oblongata approach, and to obtain the most sufficient surgical field without opening the lower vermis. Resection of cerebellar medullary fissure, pontine, and periventricular space occupying lesions. To provide reference for guiding clinical operation. Methods five adult cadaveric head specimens fixed by formaldehyde and perfused with vascular latex were dissected layer by layer according to different surgical approaches to observe the morphological structure and adjacent relationship of related tissues and blood vessels. Measurement and statistical analysis were made. 20 cases of cerebellar medullary fissure, periventricular and pontine lesions were surgically resected, combined with incision and prognosis, by using different incision methods of cerebellar medullary fissure. The excision and exposure degree of related lesions were described and analyzed, and 3 typical cases were described. Results the cerebellar medullary fissure approach did not need to open the lower part of the vermis, but could be exposed from the latch to the inferior orifice of aqueduct and laterally from the latch to the lateral foramen of the fourth ventricle and the dorsolateral region of the pontine. Compared with the inferior cerebellar approach, the longitudinal exposure distance of cerebellar medullary fissure approach was not different (P > 0.05), and the lateral exposure distance was significantly larger than that of the inferior vermis approach (P < 0.05). The cerebellar medullary fissure approach without incision of the lower vermis can clearly expose any part of the fourth ventricle from the inferior aqueduct to the latch through the lateral recess to the lateral foramen and dorsolateral pontine. Extensive CMF incision was performed in 11 cases, lateral wall incision in 7 cases and lateral recess incision in 2 cases. There were 16 cases with good exposure and 10 cases with poor exposure and difficult exposure. Total resection was performed in 10 cases, subtotal resection in 6 cases and partial resection in 4 cases. At discharge, 12 patients with 5 scores of GOS prognosis score and 8 patients with 4 scores had no severe disability or death. There were no new symptoms of neurological deficit after operation. Pathological diagnosis included 6 cases of ependymoma, 3 cases of astrocytoma, 3 cases of medulloblastoma, 3 cases of cavernous hemangioma, 2 cases of epithelioid cyst, 1 case of choroid plexus papilloma, 1 case of cerebral arteriovenous malformation and 1 case of hemangioblastoma. Conclusion the cerebellar medullary fissure approach can fully expose CMF, peri-fourth ventricle, pons, and compare the approach of inferior vermis. The approach of cerebellar medulla oblongata has less injury to nerve tissue and improves the safety of operation. The normal anatomical space of cerebellomedullary fissure reached periventricular and dorsal pons. The clinical application of this approach can reduce neurological dysfunction and postoperative complications.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2009
【分類號】：R651;R322

【參考文獻】

相關(guān)期刊論文 前1條

1 王貴懷,王忠誠,孫梅珍,石祥恩,宋詠梅,孫邦燕,郭之通,杜新建,高勇;延髓閂部損害后呼吸循環(huán)變化[J];中華神經(jīng)外科雜志;1997年01期

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本文編號：2044491