改良Poppen入路松果体区病变显微切除术的常见并发症及其防治  

Prevention and treatment of complications following resection of pineal lesions via modified Poppen approach

作　　者：程传东[1] 计颖[1] 牛朝诗[1] 凌士营[1] 傅先明[1] 汪业汉[1] Cheng Chuandong;Ji Ying;Niu Chaoshi;Ling Shiying;Fu Xianming;Wang Yehan(Department of Neurosurgery, Anhui Provincial Hospital, Anhui Province Key Laboratory of Brain Function and Brain Disease, A nhui Provincial Stereotactic Neurosurgical Institute, Hefei 230001, China)

机构地区：[1]安徽省立医院神经外科、脑功能与脑疾病安徽省重点实验室、安徽省脑立体定向神经外科研究所,合肥230001

出　　处：《中华神经医学杂志》2018年第6期615-619,共5页Chinese Journal of Neuromedicine

基　　金：安徽省自然科学基金青年项目（1508085QH184）;安徽省公益性研究联动计划项目（15011d04033）

摘　　要：目的探讨改良Poppen入路松果体区病变显微切除术的常见并发症及其防治措施。方法安徽省立医院神经外科自2008年1月至2017年12月采用改良Poppen入路显微手术切除松果体区病变62例，回顾性分析患者的临床资料和疗效，比较不同病变直径、小脑幕夹角及术前有无幕上脑积水患者术后并发症发生率的差异。结果本组病变全切除48例，次全切除10例，大部切除4例。患者出院后随访3-12个月，术后并发症为：偏盲2例，3个月后恢复；枕叶损伤7例，其中颅内血肿3例，均再次行血肿清除术；共济失调4例；一侧肢体偏瘫2例；颅内感染2例。病变直径〉4．5cm组患者术后偏盲、偏瘫的发生率高于病变直径≤4．5cm组，小脑幕夹角〉60°组患者术后偏盲的发生率高于小脑幕夹角≤60。组，差异均有统计学意义（P〈0．05）。结论病变的大小、小脑幕夹角与改良Poppen人路松果体区病变显微切除术后的并发症密切相关。术前全面评估、熟悉的解剖、娴熟的显微手术技巧以及个体化的手术方案是减少手术并发症的关键。Objective To explore prevention and treatment of complications following resection of pineal lesions via the modified Poppen approach. Methods From January 2008 to December 2017, 62 patients received resection of pineal region lesions via the modified Poppen approach at Department of Neurosurgery, Anhui Provincial Hospital. Their clinical data and outcomes were reviewed. The incidences of postoperative complications were compared between the patients with differences in lesion diameter, tentorial angle and preoperative hydrocephalus. Results Of this cohort, total tumor resection was performed in 48, subtotal resection in 10 and partial resection in 4. Follow-ups from 3 to 12 months revealed 2 cases of hemianopia which were recovered 3 months later, 7 cases of occipital lobe contusion, 2 cases of monoparesis and 2 cases of intracranial infection. Of the 7 cases of occipital lobe contusion, 3 had intracranial hematoma which had been removed by secondary surgery and 4 had ataxia. The incidences of postoperative hemianopia and monoparesis for the patients with a lesion 〉4.5 cm in diameter were significantly higher than for those with a lesion ≤4.5 cm in diameter （P〈0.05）. The incidence of postoperative hemianopia for the patients with a tentorial angle 〉60° was significantly higher than for those with a tentorial angle ≤ 60° （P〈0.05）. Conclusions Size and tentorial angle of the lesion may be closely associated with the complications following resection of pineal lesions via the modified Poppen approach. The key to reducing the postoperative complications lies in comprehensive preoperative assessments, familiarity with clinical anatomy of the Poppen approach, sophisticated surgical skills and an individualized surgical protocol.

关 键 词：松果体区病变 改良Poppen入路 手术并发症 

分 类 号：R739.4[医药卫生—肿瘤]