侧脑室内肿瘤的显微外科治疗  

Microsurgical treatment of lateral ventricular tumors

作　　者：杨正明[1] 陈坚[1] 陈劲草[1] 周游[1] 王玉平[1] 张平[1] 鲍文公[1] 雷霆[1] 

机构地区：[1]华中科技大学同济医学院同济医院神经外科,武汉市430030

出　　处：《中华显微外科杂志》2008年第5期332-334,共3页Chinese Journal of Microsurgery

摘　　要：目的探讨侧脑室内肿瘤的临床特点及显微手术方式，旨在提高对该疾病的认识及手术疗效。方法65例侧脑室内肿瘤，男39例，女26例，首发症状主要是头痛、呕吐（48例）；分别经皮层-脑室前入路（34例）、皮层-脑室后入路（20例）和胼胝体前部入路（11例）采用显微外科技术切除；回顾分析其临床特点、手术方式、病理诊断及术后并发症。结果手术全切54例，大部分切除11例。术后病理诊断以室管膜瘤及星形细胞瘤最常见。术后并发症：术后发热26例；术后脑积水9例；脑室内积血或血肿形成7例，其中2例因出现意识障碍后行开颅血肿清除术；术后癫痫7例；术后出现意识障碍4例，均治疗后好转；伤口感染3例。手术死亡3例，其中2例系继发术后癫痫出现呼吸衰竭死亡。结论早期发现侧脑室内肿瘤、周密的手术方案和精细的显微操作以及正确的术后处理是提高显微手术治疗侧脑室内肿瘤全切率、减少术后并发症和死亡率的关键。Objective To investigate the clinical characteristics, minimal invasive operation tech nique and perioperative management of lateral ventricular tumors. Methods The clinical characteristics, image diagnosis, surgical approaches and postoperative management and surgical outcomes of 65 consecutive cases of lateral ventric^ar tumors were retrospectively analyzed. Results In our series, total resection was achieved in 54 cases, and subtotal resection was achieved in 11 cases. Lateral ventricular tumors were mostly found in male and in the left side. Headache caused by increased intracranial pressure was the most common clinical symptom. Ependymocytoma and astrocytic glioma are the most common pathologic diagnosis. Postoperative complications included fever （26 cases）, hydrocephalus （9 cases）, intraventricular hematoma （7 cases） of which 2 cases were evacuated by craniotomy, epilepsy （7 cases）, wound infection （3 cases）. Postoperative death was happened in 3 cases. Two of them died of respiratory failure due to postoperative epilepsy. Conclusion Early discovery of lateral ventricle tumors, meticulous operation, subtle microma- nipulation and right postoperative treatment are the criticality to improve the rate of total resection of lateral ventricle tumors through microsurgical treatment and reduce postoperative complications and mortality.

关 键 词：侧脑室 肿瘤 显微手术 并发症 

分 类 号：R739.45[医药卫生—肿瘤]