脑干肿瘤的显微外科治疗  

Microsurgical treatment for brain stem tumor

作　　者：蒋宇钢[1] 陈靖[1] 彭雍[1] 周倩[1] 

机构地区：[1]中南大学湘雅二医院神经外科,长沙市410011

出　　处：《中华显微外科杂志》2008年第5期324-327,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨脑干肿瘤的临床表现、病理及神经影像学特点，及其手术适应证、入路和显微手术技巧。方法回顾性分析17例应用显微外科手术治疗的脑干肿瘤的临床资料。其中10例采用枕下后正中入路，应用于5例脑桥肿瘤，3例延髓肿瘤，2例位于脑桥下段累及延髓上部的肿瘤；4例采用枕下乳突后入路。应用于2例脑桥肿瘤，1例延髓肿瘤，1例主体位于脑桥侧方累及部分中脑的肿瘤；3例中脑不同部位肿瘤分别采用枕下幕上入路、颞枕下入路及翼点入路。结果病变全切除16例，次全切除1例，无手术死亡。随访5个月～4年，总体效果良好，7例恢复正常生活，4例可从事轻微体力活动，3例生活基本自理，2例需人照料，1例因肺部感染于出院后6个月死亡。结论适宜的手术入路和精细的显微外科技巧，可显著提高治愈率、降低致残率。Objective To investigate the clinical manifestation, pathological characteristics, neurological imaging, indications, operative approach and microsurgical technique of surgery for brain stem tumor. Methods 17 cases of brain stein tumor treated by applying microsurgical skills were retrospectively analyzed from Jan. 2002 to Dec. 2007. Ten cases were operated via the suboccipito-retromastoid approach, among which 5 situated in pens, 3 in medulla oblongata and 2 invoved both pens and medulla oblongata; 4 cases were performed via the posteromedian-suboccipital approach, among which 2 located in pens, 1 in medulla oblongata and 1 involved both midbrain and pons; 3 lesions situated in varying sites of mesencephalon were operated by the suboccipito-supratentorial, infratemporal approach and pterional approach respectively. Results In the series of the patients, lesion was totally excised in 6 cases, subtotally in one, without surgical mortality. All patients were followed up for years ranging from 5 months to 4 years. During the follow-up period, seven patients resumed work and normal life; 4 patients could perform physical labor; 3 patients obtained self care capability; 2 patients needed to be taken care of, 1 patient died from pneumonia after discharge. COnclusion Fine therapeutic efficacy and low disability rate could be obtained while applying microsurgical techniques to resect brain stem tumors with correct indication, appropriate approach and elaborate microneurosurgical skills.

关 键 词：脑干 肿瘤 显微外科手术 

分 类 号：R739.4[医药卫生—肿瘤]