本文選題：圍腦干腫瘤　切入點：核磁共振　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的分析圍腦干腫瘤的臨床癥狀體征、核磁共振影像學(xué)表現(xiàn)、手術(shù)入路方式、相關(guān)并發(fā)癥術(shù)后對策及預(yù)后。方法回顧分析本院神經(jīng)外科2013年3月至2016年5月經(jīng)顯微外科手術(shù)治療的61例圍腦干腫瘤病人的相關(guān)臨床資料,從腫瘤對腦干的不同受壓部位所出現(xiàn)的癥狀體征、核磁共振影像學(xué)表現(xiàn)、手術(shù)入路方式、相關(guān)并發(fā)癥術(shù)后對策及預(yù)后予以總結(jié)分析。結(jié)果腦干功能十分重要,圍腦干腫瘤的臨床特點復(fù)雜多樣,頭痛、錐體束征和腦神經(jīng)功能損害等癥狀較術(shù)前明顯緩解;影像學(xué)檢查能夠確定腫瘤從不同角度壓迫腦干的程度、手術(shù)入路的選擇。顯微鏡下腫瘤全部切除42例(68.8%),次全切除12例(19.7%),大部分切除7例(11.5%),死亡3例(4.9%)。病理檢查結(jié)果:13例神經(jīng)鞘瘤,8例髓母細胞瘤,8例室管膜瘤,7例腦膜瘤,5例血管母細胞瘤,4例表皮樣囊腫,4例星形細胞瘤,3例顱咽管瘤,3例海綿狀血管瘤,2例膠質(zhì)母細胞瘤,2例巨大垂體瘤,1例轉(zhuǎn)移癌,1例生殖細胞瘤;術(shù)后主要并發(fā)癥:10例高熱,1例中樞性呼吸困難,4例癲癇,1例昏迷,15例吞咽困難,4例面癱,4例聽力下降,19例肢體無力,7例復(fù)視,13例肺部感染,2例小腦緘默癥,6例顱內(nèi)感染,5例應(yīng)激性潰瘍,3例頭皮下積液,12例腦積水,5例硬膜下積液,1例腦出血。術(shù)后在專業(yè)醫(yī)師指導(dǎo)下進行病變神經(jīng)康復(fù)功能鍛煉,大部分病人癥狀得到改善。經(jīng)過3-6個月隨訪,對患者生活質(zhì)量進行評估,應(yīng)用Barthel指數(shù)評定量表,45例60分以上,9例40-60分,4例20-40分。60分以上的為預(yù)后良好,60分下的為預(yù)后不良。結(jié)論圍腦干腫瘤的臨床癥狀以腦神經(jīng)功能損傷為主,并發(fā)癥多而復(fù)雜。核磁共振影像學(xué)檢查對圍腦干腫瘤的診斷、定位及治療方面重要意義。手術(shù)入路應(yīng)考慮腫瘤的位置、大小、血供、壓迫腦干的方向,在盡量全切腫瘤的情況下,避免神經(jīng)牽拉及損傷。圍腦干腫瘤術(shù)后并發(fā)癥較嚴(yán)重,致殘率高,部分預(yù)后良好,提高手術(shù)質(zhì)量是關(guān)鍵,積極處理和預(yù)防并發(fā)癥對改善患者預(yù)后有很大的作用,經(jīng)隨訪發(fā)現(xiàn)術(shù)后出現(xiàn)腦積水的患者預(yù)后差。
[Abstract]:Objective to analyze the clinical symptoms and signs, MRI findings and operative approach of brain stem tumors. Methods the clinical data of 61 patients with peribrainstem tumors treated by microsurgery from March 2013 to 2016 were retrospectively analyzed. The symptoms and signs of tumor in different compression sites of brain stem, MRI findings, operative approach, postoperative complications and prognosis were summarized and analyzed. Results brain stem function is very important. The clinical features of brain stem tumors are complicated and varied, headache, pyramidal beam sign and brain nerve function damage are more relieved than those before operation, and imaging examination can determine the degree of compression of brain stem from different angles. Selection of operative approach. Total resection of tumors under microscope was performed in 42 cases (68.8%), subtotal resection in 12 cases (19.7%), major resection in 7 cases (11. 5%), death in 3 cases (4. 9%). Pathological examination of 13 cases of schwannoma, 8 cases of medulloblastoma, 8 cases of ependymoma, 7 cases of ependymoma. 5 cases of hemangioblastoma 4 cases of epidermoid cyst 4 cases of astrocytoma 3 cases of craniopharyngioma 3 cases of cavernous hemangioma 2 cases of glioblastoma 2 cases of giant pituitary tumor 1 case of metastatic carcinoma 1 case of germ cell tumor; Major postoperative complications: 10 cases of hyperpyrexia 1 case of central dyspnea 4 cases of epilepsy and 1 case of coma 15 cases of dysphagia 4 cases of facial paralysis 4 cases of hearing loss 7 cases of limb weakness 7 cases of diplopia 13 cases of pulmonary infection 2 cases of cerebellar mutism 6 cases of cranium. There were 5 cases of stress ulcer and 3 cases of hydrocephalus 12 cases of hydrocephalus 5 cases of subdural effusion and 1 case of cerebral hemorrhage. Most of the patients' symptoms improved. After 3-6 months follow-up, the quality of life of the patients was evaluated. The Barthel index was used to evaluate 45 cases with more than 60 points, 9 cases with 40-60 scores and 4 cases with 20-40 scores. The prognosis of the patients with the scores above 60 was good and the prognosis with the score above 60 was poor. Conclusion the clinical symptoms of peribrainstem tumors are mainly brain nerve function damage. The complications are numerous and complicated. Magnetic resonance imaging is of great significance in the diagnosis, localization and treatment of peribrainstem tumors. The location, size, blood supply and direction of compression of the brain stem should be taken into account in the operative approach. In the case of total resection of tumor, nerve traction and injury should be avoided. The complications of brain stem tumor after operation are serious, the rate of disability is high, and some prognosis is good. Improving the quality of operation is the key. Active management and prevention of complications have great effect on improving the prognosis of patients with hydrocephalus after follow-up found that the prognosis of patients with hydrocephalus is poor.
【學(xué)位授予單位】：鄭州大學(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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