幕上脑室及脑室旁肿瘤术后继发梗阻性脑积水的预防及治疗  

Prevention and Treatment of Postoperative Obstructive Hydrocephalus to Supratentorial Intraventricular and Paraventricular Tumors

作　　者：付强[1] 李绍山[1] 刘力豪 王增亮[1] 刘波[1] 周庆九[1] Fu Qiang;Li Shaoshan;Liu Lihao;Wang Zengliang;Liu Bo;Zhou Qingjiu(Department ofNeurosurgery,the First Affiliated Hospital ofXinjiangMedical University,Urumqi,Xinjiang,830054,China)

机构地区：[1]新疆医科大学第一附属医院神经外科

出　　处：《新疆医学》2019年第6期545-550,共6页Xinjiang Medical Journal

基　　金：新疆维吾尔自治区自然科学基金，（项目编号：2012211A079）

摘　　要：目的探讨幕上脑室及脑室旁肿瘤术后继发梗阻性脑积水的预防及治疗方法。方法回顾性分析新疆医科大学第一附属医院神经外科脑肿瘤病区自2015年1月-2018年9月手术的75例幕上脑室及脑室旁肿瘤患者的临床资料,因自2017年采用新的脑室引流方法,故将上述病例分为A组41例(2015年1月-2016年12月),B组34例(2017年1月-2018年9月),对比两组术后梗阻性脑积水发生率及侧脑室腹腔分流术手术率,采用电话、门诊等方式进行随访1-6月。结果A组:胶质母细胞瘤13例,脑膜瘤10例,间变星形细胞瘤4例,室管膜瘤4例,淋巴瘤3例,室管膜下巨细胞星形细胞瘤2例,中枢神经细胞瘤2例,转移瘤1例,胶样囊肿1例,脉络丛乳头状瘤1例;术前伴有梗阻性脑积水33例占80.5%;肿瘤全切21例占51.2%,次全切13例占31.7%,部分切除7例占17.1%;术后梗阻性脑积水21例占51.2%,分流手术13例占31.7%;出院38例中观察14例,放化疗24例,昏迷放弃3例。B组:胶质母细胞瘤12例,中枢神经细胞瘤7例,淋巴瘤3例,间变星形细胞瘤2例,转移瘤2例,室管膜瘤2例,脑膜瘤2例,室管膜下巨细胞星形细胞瘤1例,炎性假瘤1例,脉络丛乳头状瘤1例,多形性黄色瘤样星形细胞瘤1例;术前梗阻性脑积水21例占61.7%;肿瘤全切16例占47.1%,次全切13例占38.2%,部分切除5例占14.7%;术后梗阻性脑积水5例占14.7%,分流手术1例占2.9%。出院32例中观察11例,放化疗21例,昏迷放弃2例。70例中3例失访,67例进行随访,随访成功率95.7%,平均随访2.7月。67例均无脑积水发生。结论幕上脑室及脑室旁肿瘤术前、术后多继发梗阻性脑积水,严重时需行手术治疗,术区放置引流管人工建立脑脊液循环通路并对引流管进行正确管理可明显降低术后梗阻性脑积水的发生率及手术率。Objective To investigate the prevention and treatment of the Obstructive Hydrocephalus after resection of Supratentorial Intraventricular and Paraventricular Tumors.Methods 75 cases of Supratentorial Intraventricular and Paraventricular Tumors were retrospective analyzed,which had been operated in the department of neurosurgery at the first affiliated hospital of Xinjiang Medical University from January 2015 to September 2018.The whole cases were divided into two groups because?of a new method of ventricle drainage which was applied Since 2017.Group A(from January 2015 to December 2016)of 41 cases,Group B(January 2017 to September 2018)of 34 cases.The occurrence rate of obstructive hydrocephalus after operation and surgery rate of Ventricloperitoneal Shunt of two groups were compared.Follow-up and outpatient service were carried out for 1-6 months.Results In group A,there were 13 cases of Glioblastoma,10 cases of Meningioma,4 cases of Anaplasia Astrocytoma,4 cases of Ependymoma,3 cases of Lymphoma,2 cases of Subependymal Giant Cell Astrocytoma,2 cases of Central Neurocytoma,1 case ofMetastatic Tumor,1 case of Colloid Cyst and 1 case of Choroid Plexus Papilloma.33 cases possessed preoperative obstructive hydrocephalus which accounted for 80.5%.21 cases got total resection which accounted for 51.2%,13 cases got subtotal resection accountingfor 31.7%and 7 cases got partial resection which accounted for 17.1%.Postoperative obstructive jydrocephalus occurred in 21 cases accounting for 51.2%and 13 cases received Ventricloperitoneal Shunt operation accounting for 31.7%.38 cases were discharged and 3 cases were abandoned,of which 14 cases were regular reviewed and 24 cases received radiotherapy and chemotherapy.In group B,there were 12 cases of glioblastoma,7 cases of central neurocytoma,3 cases of lymphoma,2 cases of meningioma,2 cases of anaplasia astrocytoma,2 cases of ependymoma,2 case of metastatic tumor,1 case of subependymal giant cell astrocytoma,1 case of inflammatory pseudotumor,1 case of choroid plexus papillo

关 键 词：幕上脑室肿瘤 幕上脑室旁肿瘤 梗阻性脑积水 治疗 

分 类 号：R651.1[医药卫生—外科学]