大型听神经瘤手术疗效分析  

Analysis of surgical outcomes in large acoustic neuroma

作　　者：张治华[1] 汪照炎[1] 黄琦[1] 杨军[1] 吴皓[1] 

机构地区：[1]上海交通大学医学院附属新华医院耳鼻咽喉头颈外科 上海交通大学医学院耳科学研究所, 200092

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第3期191-195,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：基金项目：国家自然科学基金面上项目（81371086）;上海申康医院发展中心新兴前沿技术项目（SHDC12013109）

摘　　要：目的 通过分析大型听神经瘤的手术效果,总结其治疗经验.方法 收集2001年1月至2012年12月共134例大型听神经瘤患者的临床资料,回顾分析其肿瘤大小、是否囊性变、手术径路、肿瘤切除范围、面神经解剖保留率、术后面神经功能以及并发症等指标.结果 129例（96.3％）患者在初次诊断或确诊复发后1个月内、院手术,5例（3.7％）患者于初诊后1年复查MRI示肿瘤仍有进行性增大后入院手术.肿瘤直径31.0 ～70.0 mm,平均（40.9±6.8）mm（x±s）,囊性变比例35.1％（47/134）.手术径路包括扩大迷路径路118例[88.1％,其中16例（11.9％）为改良扩大迷路径路],耳囊径路16例（11.9％）.肿瘤全切、近全切、次全切除率分别为91.0％（122/134）,6.7％ （9/134）和2.2％（3/134）.术中面神经解剖保留率达88.8％（119/134）,其中囊性听神经瘤面神经解剖保留率（80.9％,38/47）明显低于实性囊性听神经瘤（93.1％,81/87）,差异具有统计学意义（P=0.044）.术后近期面神经功能良好率为32.3％（43/133）,远期达36.8％（49/133）.并发症总发生率为17.9％（24/134）,其中脑脊液漏发生率为7.5％（10/134）;死亡率为0.7％（1/134）;术后随访1～5年,平均随访（2.7±0.4）年,4例出现复发.结论 大型听神经瘤治疗策略以手术为主,即使暂时不行手术,亦应定期观察,尽早手术.虽然手术切除安全可靠,死亡率和并发症率均较低,但术前仍应详尽告知患者术后可能存在的风险.肿瘤囊性变是影响手术效果（特别是术后面神经功能）的重要因素.Objective To analyze the surgical outcomes and share experience in the surgical management of acoustic neuroma（AN）.Methods A retrospective review was performed in 134 patients with sporadic large ANs operated from Jan.2001 to Dec.2012.The patients＆#39; information,tumor size,tumor cystic degeneration,surgical approach,intraoperative anatomical facial nerve integrity rate,postoperative facial nerve function and complications were recorded.Results There were one hundred and twenty-nine patients （96.3%） received surgeries within one month after first diagnosis of vestibular schwannoma（VS） or definite diagnosis of recurrence.Five patients （3.7%） hesitated to be operated until tumor was found to be growing on MRI during the follow-up.The average tumor diameter was about （40.9 ＆#177; 6.8） mm （31.0 ～ 70.0 mm）.The cystic tumor percentage arrived at 35.1% （47/134）.The surgical approaches included 118 （88.1%） translabyrinthine approaches,comprising 16 （11.9%） modified enlarged translabyrinthine approaches,and 16 （11.9%） transotic approaches.Total,near total,and subtotal tumor removal rate was 91.0% （122/134）,6.7% （9/134） and 2.2% （3/134）,respectively.The anatomical facial nerve integrity was preserved in 88.8% （19/134） of all patients.And it was significantly lower in cystic VS （80.9% vs 93.1%,P =0.044）.There were 32.3% （43/133） and 36.8% （49/133） of patients had a good postoperative facial nerve function in short-term （discharge from hospital） and long-term （1 year） followup,respectively.General rate of complications was 17.9% （24/134）.CSF leakage occurred in 7.5% of patients.Mortality rate was 0.7 % （1/134）.Follow-up time ranged from 1 to 5 years,average time was （2.7 ＆#177;0.4） years.Four cases ocourred recurrence.Conclusions Major management strategy of large AN is surgicalresection.Even for those who had temporary antagonism for surgery,the wait and scan policy is necessary.Although the tumor removal is safe and accompanies

关 键 词：神经瘤 听 耳外科手术 手术中并发症 手术后并发症 

分 类 号：R739.4[医药卫生—肿瘤]