侧脑室三角区肿瘤显微手术治疗的初步临床分析  

Preliminary analysis of microsurgery for tumors at the trigone of the lateral ventricle

作　　者：韩超 牛朝诗[1] 丁宛海 程伟 鲍得俊 

机构地区：[1]安徽医科大学附属省立医院神经外科脑功能与脑疾病省重点实验室,安徽合肥230001 [2]阜阳市第五人民医院神经外科,安徽阜阳236000

出　　处：《国际神经病学神经外科学杂志》2017年第4期389-392,共4页Journal of International Neurology and Neurosurgery

基　　金：脑功能与脑疾病安徽省重点实验室绩效考核补助项目;编号:1506c085017;1606c08235

摘　　要：目的探讨不同手术入路显微镜下行侧脑室三角区肿瘤的手术治疗方法。方法对47例肿瘤位于侧脑室三角区并经显微手术治疗的患者相关资料进行回顾性分析,详细分析不同手术入路及术中操作技巧。结果 42例患者颅内肿瘤显微镜下全切,5例因肿瘤较大、界限不清部分切除,其中,2例胶质瘤和1例星型母细胞瘤部分切除+去骨瓣减压术,1例间变性室管膜瘤因肿瘤生长至对侧,部分切除术后复发;1例胶质肉瘤,出现迟发性术区出血,急诊行手术清除术区脑内血肿,第二天死亡。1例同侧术后出现硬膜外血肿,血肿量不多,未再次手术,经积极治疗逐渐吸收。5例患者术后合并颅内感染,行腰大池脑脊液持续引流,感染痊愈,预后良好。出院时GOS评分:39例预后评分5分,4例预后评分4分,1例评分3分,1例预后评分2分,2例评分1分。结论对于不同类型、不同生长方向的侧脑室三角区肿瘤,在影像导航系统指引下,选择合适的手术入路、不断提高手术技巧,可明显减少患者的功能损伤及手术并发症的出现,改善患者的预后。Objective To investigate the clinical values of different microsurgical approaches for tumors at the trigone of the lateral ventricle.Methods The clinical data of 47 patients who underwent microsurgery for tumors at the trigone of the lateral ventricle were retrospectively analyzed,and the clinical values of different surgical approaches and surgical techniques were also analyzed.Results Atotal of 42 patients underwent total tumor resection.Five patients had partial tumor resection because of large tumor sizes and unclear boundaries;among the 5 patients,3 patients （2 cases of gliomas and 1 case of astroblastoma） also underwent decompressive craniectomy,and 1 patient with anaplastic ependymoma which had grown to the opposite side relapsed after partial tumor resection.One patient with glial sarcoma developed delayed hemorrhage in the surgical area and then had an emergency operation to remove the intracerebral hematoma from the surgical area,but died on the second day.One patient had epidural hematoma at the same side after surgery and achieved gradual absorption through active treatment without the secondary surgery.Five patients had intracranial infection after surgery,and they were cured of infection and achieved good prognosis after continuous drainage of cerebrospinal fluid from the lumbar cistern.The Glasgow Outcome Scale scores at discharge were as follows：39 patients got 5 points,4 got 4 points,1 got 3 points,1 got 2 points,and 2 got 1 point.Condusions For patients with different types and growth directions of tumors at the trigane of the lateral ventricle,appropriate surgical approaches under the guidance of the imaging navigation system and proficient surgical skills are associated with reduced function damage,reduced complications,and good outcome.

关 键 词：侧脑室三角区 脑肿瘤 显微外科手术 

分 类 号：R739.41[医药卫生—肿瘤]