颅底肿瘤术后再手术原因的分析（附14例报告）  

Analysis the reasons of emergency reoperation after skull base surgery： report of 14 cases

作　　者：郝淑煜[1] 薛湛[1] 李达[1] 肖新如[1] 汤劼[1] 王亮[1] 吴震[1] 张力伟[1] 张俊廷[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华神经外科杂志》2015年第4期329-331,共3页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（81341059）;北京市科技新星计划（2012033）

摘　　要：目的 探讨神经外科颅底肿瘤手术后急诊再次开颅手术病例的临床特征.方法 回顾性分析首都医科大学附属北京天坛医院神经外科2008年10月至2013年10月2 500例颅底手术病例中术后再次急诊开颅手术的14例患者,其中颅底脑膜瘤6例,神经鞘瘤3例,垂体腺瘤、颅咽管瘤、骨软骨瘤、血管平滑肌瘤、颈静脉球瘤各1例.第一次手术平均用时9.2h,术中平均出血2 750 ml.再手术的原因由术者和专家组分析得出,并由全科讨论确认.结果 再手术的14例患者中,9例表现为意识减弱,2例术后未能正常苏醒,2例术后常规CT检查发现异常,1例为突发性伤口出血.CT检查发现异常的平均时间为术后17 h,其中瘤腔内出血4例,脑内血肿伴脑挫裂伤4例,大面积脑梗死2例,脑内血肿合并硬膜下血肿l例,硬膜外血肿2例,椎动脉出血1例.再手术后恢复良好6例,中残2例,重残2例,植物生存1例,死亡3例.结论 对于行颅底肿瘤手术的患者,应加强围手术期管理,减少再次手术的发生。Objective To report the clinical features of the patients who underwent emergent recraniotomy after skull base operation.Methods A serial of 14 cases of reoperation after elective surgery in the Department of Neurosurgery,Beijing Tiantan Hospital between October 2008 and October 2013 were reviewed.Six cases were skull basal meningioma,3 schwannoma,1 pituitary adenoma,1 craniopharyngioma,1 chondroma,1 angioleiomyoma,and 1 glomus jugular tumor.The mean length of first operation time was 9.2 h,and the mean amount of bleeding was 2 750 ml.The reason of reoperation was evaluated by the surgeons and experts,and then approved by all doctors.Results The clinical features of these reoperation patients included altered level of consciousness in 9 cases,unrecovered from anesthesia in two,abnormal CT scan in two and one sudden bleeding in wound.The mean time of abnormal CT scan was 17 h.As for the reason for reoperation,the tumor cavity bleeding was found in 4 cases,intracerebral hematoma and brain contusion in 4,massive brain infarction in 2,intracerebral hematoma and subdural hematoma in 1,epidural hematoma in 2,and vertebral artery dissection in 1.Six patients lived a normal life after the second operation,2 moderate disability,2 severe disability,1 persistent vegetative state,and 3 died.Conclusion For skull base surgery,the perioperative management should be reinforced to decrease the emergency reoperation.

关 键 词：神经外科手术 颅底肿瘤 再手术 

分 类 号：R739.41[医药卫生—肿瘤]