枕下经颈-颈静脉突入路切除颈静脉孔肿瘤临床初探  

Preliminary experience of applying the suboccipital transcervico-jugular process approach to remove jugular foramen tumors

作　　者：朱权[1] 袁贤瑞[1] 刘庆[1] 姜维喜[1] 罗端午[1] 黄军[1] 

机构地区：[1]中南大学湘雅医院神经外科,湖南长沙410008

出　　处：《中国耳鼻咽喉颅底外科杂志》2006年第1期18-22,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：湖南省卫生厅科研基金资助项目(ZD02-05)

摘　　要：目的 探讨枕下经颈-颈静脉突（STJP）入路切除颈静脉孔肿瘤的临床价值及适用范围。方法 回顾总结2000年1月以来经STJP入路手术的14例颈静脉孔肿瘤病人的临床资料及术后随访情况。结果 14例颈静脉孔肿瘤中，1例局限于颈静脉孔区；5例向颅内发展；其余8例虽肿瘤主体位于颅内，但部分瘤体长至颅外，其中2例跨枕大孔进入颈椎管上部，6例呈哑铃型长出至颈静脉孔外口处，后者中有2例向前累及颈动脉鞘。手术全切除10例，近全切除1例，次全切除3例。无1例发生术后脑脊液漏。术后1例病人出现短期患侧眼外展麻痹和面神经不全损害（HBⅢ级），余13例（92．9％）无新增脑神经损害表现。除1例病人失访外，其余病人均随访3～60个月，随访时术前原脑神经损害均已逐渐恢复或代偿，无1例残留吞咽困难。结论 STJP入路显露范围较广泛，操作简便，不破坏迷路，无需轮廓化面神经管，对颅底结构破坏较少，适用于切除主体向颅内发展为主的颈静脉孔肿瘤。Objective To explore the clinical value and applicability of the suboccipital transcervico-jugular process （STJP） approach to jugular fosmen （JF） tumors. Methods All clinical materials, operation details, and the follow-up results of 14 patients suffering from JF tumors which were removed through STJP approach from January 2000 were analyzed and summarized. Results Among the tumors of 14 cases, 1 tumor located only at JF, 5 tumors extended totally inside cerebello-pontine angle （CPA） area from JF, and the other 8 tumors remained mainly inside CPA area with parts of the tumor downward： 2 grew into upper cervical canal and 6 grew outside JF, 2 of the latter invaded forward involving carotid Ten tumors were totally removed while 1 nearly total removed and 3 subtotal removed. No leakage of cerebrospinal fluid occurred in all cases. There were no any new cranial nerve injuries in 13 cases （92.9 %） after operation except 1 suffering from short-term ocular abduction palsy and moderate facial nerve paralysis. All patients were followed up 3-60 months except one being lost. All the preoperative impairments of cranial nerves have gradually retrieved and no patient presented dysphagia at the time of consultation. Conclusion STJP approach has a relatively extensive exposure, It is easily operated without skeletonization of facial nerve canal. It also has the advantage of no damage to labyrinthus and less defect to cranial base structure. This approach specifically suits for those JF tumors with intraeranial extension.

关 键 词：枕下经颈-颈静脉突入路 颈静脉孔肿瘤/外科学 显微外科手术 

分 类 号：R739.41[医药卫生—肿瘤] R779.62[医药卫生—临床医学]