Poppen入路在颅内肿瘤中的临床应用(附311例报告)  

Clinical application of Poppen approach in the CNS tumors:A review of 311 cases

作　　者：方陆雄[1] 宋烨[1] 却天石 陆杰 彭玉平[1] 樊俊[1] 漆松涛[1] Fang Luxiong;Song Ye;Que Tianshi;Lu Jie;Peng Yuping;Fan Jun;Qi Songtao(Department of Neurosurgery,Nanfang Hospital of Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院神经外科,广州510515

出　　处：《中华神经外科杂志》2020年第9期936-940,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨Poppen入路在颅内肿瘤中的临床应用。方法回顾性分析2004年1月至2018年6月南方医科大学南方医院神经外科经Poppen入路手术治疗的311例颅内肿瘤患者的临床资料。311例患者的肿瘤位置为:松果体区221例、丘脑23例、中脑31例、小脑7例、小脑幕29例。术后对所有患者行头颅MRI检查,以判断肿瘤的切除程度。结果 311例患者共行316次手术,其中3例因肿瘤复发再次手术,2例因肿瘤残留再次手术,手术均成功。术后复查头颅MRI显示,280例(90.0%)患者为肿瘤完全切除,10例(3.2%)为肿瘤次全切除,21例(6.8%)为肿瘤部分切除。术前合并脑积水的208例患者中,术后177例(85.1%)症状得到改善;术前无脑积水的103例患者中,术后13例(12.6%)发生脑积水。311例患者中,术后3例出现偏瘫,出院时肢体肌力均有不同程度的恢复;4例昏迷,其中2例病情稳定,但家属放弃治疗,另2例至出院时病情仍危重;5例死亡,其中1例因急性脑积水处理不及时,1例因脑积水外引流并发颅内感染,1例因脑静脉系统损伤致严重脑肿胀,2例因术区出血昏迷致多器官功能衰竭。术后病理学结果显示,生殖细胞肿瘤118例,神经上皮肿瘤72例,松果体实质肿瘤51例,脑膜瘤29例,其他占位性病变41例。结论 Poppen入路的适应证范围广泛,除松果体区肿瘤外,还可用于治疗包括脑干、丘脑、小脑等区域的肿瘤,且术后疗效较好。Objective To investigate the expanded application of Poppen approach in the CNS(central nervous system)tumors.Methods From January 2004 to June 2018,311 patients with CNS tumors underwent operation through Poppen approach at Department of Neurosurgery,Nanfang Hospital of Southern Medical University.Their clinical data were retrospectively reviewed.There were 221 cases originating from the pineal region,23 cases from the thalamus,31 cases from the midbrain,7 cases from the cerebellum and 29 cases from the tentorium cerebelli.Postoperative MRI examination was regularly performed to evaluate the extent of tumor resection.Results A total of 316 operations,including 3 re-operations due to tumor recurrence and 2 re-operations due to residual tumor,were successfully performed in 311 patients.Postoperative MRI revealed that total resection was achieved in 280(90.0%)cases,subtotal resection in 10(3.2%)and partial resection in 21(6.8%).Among 208 patients suffering from preoperative hydrocephalus,177(85.1%)achieved symptomatic improvement after operation.Among 103 patients without preoperative hydrocephalus or with improved hydrocephalus after conservative treatment,13(12.6%)suffered from postoperative hydrocephalus.Out of all 311 patients,3 suffered from postoperative hemiplegia with improved symptoms to different degrees at discharge,and 4 suffered from postoperative coma and included 2 with stable conditions whose families refused therapy and 2 with critical conditions at discharge.There were 5 cases of death due to different causes,including 1 case of acute hydrocephalus who did not undergo timely treatment,1 case of intracranial infection due to external drainage for hydrocephalus,1 case of severe cerebral swelling because of damage of the venous system,and 2 cases of multiple organ dysfunction syndrome.According to postoperative pathological examinations,there were 118 cases of germ cell tumor,72 cases of neuroepithelial tumor,51 cases of pinealoma,29 cases of meningioma and 41 cases of other rare types.Conclusion The

关 键 词：脑肿瘤 显微外科手术 治疗结果 POPPEN入路 

分 类 号：R739.41[医药卫生—肿瘤]