经口咽入路齿状突切除并Ⅰ期颈枕融合治疗合并延颈髓腹侧受压之颅颈交界区病变  

Transoral-transpharyngeal approach combined with simultaneous posterior occipitocervical fusion to treat cranio-cervical junction lesion with compressed ventral area of medulla oblogata and cervical spinal cord

作　　者：何家全 杨辉[3] 黄其林[3] 吕胜青[3] 刘仕勇[3] 刘海鹏[3] 

机构地区：[1]南充市中心医院神经外科 [2]川北医学院第二临床医学院,四川南充637000 [3]第三军医大学新桥医院神经外科,重庆400037

出　　处：《西部医学》2013年第11期1640-1643,共4页Medical Journal of West China

摘　　要：目的探讨经口咽入路齿状突切除并Ⅰ期颈枕融合治疗合并有腹侧延颈髓受压之颅颈交界区病变的临床效果。方法合并有腹侧延颈髓受压之颅颈交界区病变患者23例,所有病人先行颈枕Ⅰ期融合,随后采用经口咽入路切除齿状突及局部增生的结缔组织,解除其对延髓、颈髓腹侧的压迫。结果平均随访16个月,痊愈15例,明显好转6例,死亡2例,其中有3例并发肺部感染,经积极治疗后痊愈。结论经口咽入路并颈枕Ⅰ期融合是治疗合并有腹侧延颈髓受压之颅颈交界区病变的首选方法,重视围手术期处理可有效预防术后并发症的发生。Objective To discuss the way and therapeutic effect of transoral-transpharyngeal approach combined simultaneous posterior occipitocervical fusion to treat the cranio-cervical junction lesion with compressed ventral area of medulla oblogata and cervical spinal cord.Methods After a posterior occipitocervical fusion,resection of odontoid process and proliferative connective tissue in 23 cranio-cervical junction lesion patients with compressed ventral area of medulla oblogata and cervical spinal cord were performed under transoral-transpharyngeal approach microscope to relieve their compression to ventral area of medulla oblongata and cervical spinal cord.Results A mean of 15 months follow-up showed that 16 cases were fully cured.6 cases were markedly improved,and 2 cases were dead.Conclusion Transoraltranspharyngeal approach with simultaneous posterior occipitocervical fusion is the first choice to the cranio-cervical junction lesion with compressed ventral area of medulla oblogata and cervical spinal cord.In addition,perioperative management can prevent postoperative complications.

关 键 词：颅颈交界区畸形 口咽入路 Ⅰ期颈枕融合 延颈髓腹侧压迫 

分 类 号：R782.05[医药卫生—口腔医学]