中国医科大学学报

中国医科大学学报
  • 中文核心期刊
  • 中国科技核心期刊
  • 中国高校百佳科技期刊
  • BA、CA收录

中国医科大学学报 ›› 2017, Vol. 46 ›› Issue (6): 505-509.doi: 10.12007/j.issn.0258-4646.2017.06.006

• 论著 • 上一篇    下一篇

延髓海绵状血管瘤的显微外科手术治疗

吴鹏飞,王明昊,崔晓,王维,赵丹,刘济源,马跃,王英奇,仇波,陶钧,王运杰   

  1. 中国医科大学附属第一医院神经外科,沈阳 110001
  • 收稿日期:2017-03-10 出版日期:2017-06-30 发布日期:2017-06-07
  • 通讯作者: 王运杰 E-mail:wyj024@vip.sina.com
  • 作者简介:吴鹏飞(1974 -),男,副教授,博士 .
  • 基金资助:
    国家自然科学基金(81602209)

Micro-surgical Treatment of Medulla Oblongata Cavernomas

WU Pengfei,WANG Minghao,CUI Xiao,WANG Wei,ZHAO Dan,LIU Jiyuan,MA Yue,WANG Yingqi,QIU Bo,TAO Jun,WANG Yunjie   

  1. Department of Neurosurgery,The First Hospital,China Medical University,Shenyang 110001,China
  • Received:2017-03-10 Online:2017-06-30 Published:2017-06-07

摘要: 目的 探讨延髓海绵状血管瘤的显微外科手术治疗体会。方法 回顾性分析显微外科手术治疗的 21 例延髓海绵状血管瘤患者的临床资料,其中男 13 例,女 8 例,年龄 22~63 岁,术前 KPS 评分 76.5±10.2。主要临床表现包括肢体活动及感觉障碍、 饮水呛咳、吞咽困难、共济失调、颈肩部疼痛、呼吸困难等。根据病灶所在部位,15 例采用后正中经脉络膜裂入路,6 例采用远外侧入路。术中均辅助行电生理监测及神经系统导航,并通过 KPS 评分对患者手术前后的生活质量进行评价,观察临床疗效及预后。结果 21 例延髓海绵状血管瘤均全部切除,无手术死亡病例。17 例患者原发神经功能障碍有不同程度缓解或消失,4 例原 有症状加重,8 例出现新的临床表现,主要包括对侧肢体肌力下降、顽固性呃逆、进行性吞咽困难伴声音嘶哑、呼吸功能下降、严重呼吸功能减弱、急性脑积水及昏迷。术后随访 8~97 个月(平均 47.6 个月),所有患者均能够生活自理,进行简单或正常的学习 和工作,未见复发,无再次出血,术后 KPS 评分 83.7±15.5。结论 延髓海绵状血管瘤出血或症状进行性加重者应行积极的手术 治疗,反复出血更是手术的绝对适应证。手术技巧和术中电生理监测及神经系统导航都有助于减少颅神经的损伤,保护脑干功能。

关键词: 延髓, 海绵状血管瘤, 显微外科手术, 神经系统导航, 神经电生理技术

Abstract: Objective To investigate the efficacy of micro-surgery for the treatment of medulla oblongata cavernomas. Methods A retrospective analysis was conducted on the clinical data of 21 patients with cavernous hemangioma who received micro-surgical treatment. Of the 21 patients,13 were men and 8 women,aged 22 to 63 years. The preoperative Karnofsky performance status(KPS)score was 76.5 ± 10.2. The main clinical manifestations included sensory disorder and difficulty swallowing etc. According to the location of the lesions ,the posterior transchoroidal fissure approach was employed for 16 patients;far-lateral approach,5 patients. Electrophysiological monitoring and nervous system navigation were supplementarily adopted in both types of surgery. Further,KPS scoring was conducted to evaluate the patients’quality of life. Results The medulla cavernous hemangioma was excised in all cases. For 17 patients with primary neurological disorders,their symptoms were alleviated or resolved;4 patients had severe symptoms and 8 presented with new clinical symptoms. A follow-up visit was conducted 8 to 97 months post-surgery(average 47.6 months). All patients were found capable of caring for themselves in daily life and performing simple or normal learning and working activities without recurrence or bleeding. The mean postoperative KPS score was 83.7 ± 15.5. Conclusion Patients with medulla cavernous hemangioma bleeding or severe symptoms should actively seek surgical treatment. Repeated bleeding is the absolute indication for surgery. Surgical skills ,electrophysiological monitoring,and nervous system navigation can reduce nervous system damage and protect the brainstem. The patient’s quality of life is expected to significantly improve after surgery.

Key words: medulla, cavernous hemangioma, micro-surgery, nervous system navigation, electrophysiological method

中图分类号: 

  • R651
[1] 滕浩,李振,车东方,曲圣涛,李明山,薛一雪,刘云会. 52例颅咽管瘤显微外科手术治疗分析[J]. 中国医科大学学报, 2014, 43(2): 185-186.
[2] 赵奕楠,胡文宇,李蕾,邓淑敏,刘芳,何志义. 延髓梗死的临床特点分析[J]. 中国医科大学学报, 2013, 42(1): 86-88.
[3] 张占帅, 王绍久, 王一丁, 林英子, 朱杰. 奥美沙坦对自发性高血压大鼠延髓腹外侧区AT1受体mRNA表达的影响[J]. 中国医科大学学报, 2009, 38(9): 666-.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!

中国医科大学学报版权所有©2018

未经允许,严禁擅自转载本站图文资料

地址:中国 沈阳市沈北新区蒲河路77号 110122

辽ICP备05014850

JOURNAL OF CHINA MEDICAL UNIVERSITY

ADDRESS: NO.77 PUHE ROAD

SHENYANG NORTH NEW AREA, SHENYANG

LIAONING PROVINCE, P.R. CHINA