颞下岩前入路切除岩斜区肿瘤的并发症及其预防  

Complications and preventive measures of modified subtemporal transtentorial approach for resection of petroclival tumors

作　　者：贺宇波[1] 张刚利[1] 郭建忠[1] 王文雄 李彩和 HE Yu-bo;ZHANG Gang-li;GUO Jian-zhong(Department of Neurosurgery,Shanxi Provincal People's Hospital,Taiyuan 030012,China)

机构地区：[1]山西省人民医院神经外科,太原030012

出　　处：《临床神经外科杂志》2020年第5期549-553,共5页Journal of Clinical Neurosurgery

基　　金：山西省卫生健康委科研课题计划项目(2019021)。

摘　　要：目的探讨颞下岩前入路切除岩斜区肿瘤的并发症及其预防措施。方法回顾性分析102例直切口颞下岩前入路切除岩斜区肿瘤患者的临床资料。术后对患者进行随访,观察肿瘤切除程度、手术并发症,分析并发症发生的原因及预防方法。比较患者术前与术后6个月的美国国立卫生研究院卒中量表(NIHSS)评分及Kamofsky功能状态(KPS)评分。结果本组患者中脑膜瘤25例、三叉神经鞘瘤52例、脊索瘤11例、胆脂瘤7例、畸胎瘤4例、转移瘤3例。肿瘤大小为(3.2±0.7)cm,全切者82例,近全切除者16例,大部分切除者4例。术后随访6~19个月。患者术后6个月的NIHSS和KPS评分均比术前明显改善(均P<0.05)。有23例患者(23.4%)出现不同程度的神经功能障碍及其他并发症,经对症治疗及康复治疗后大部分患者恢复良好,死亡患者1例。结论颞下岩前入路切除岩斜区肿瘤的并发症发生率仍较高。术前应进行严格的全面评估,实现个体化治疗,预防和减少并发症的发生,以达到最佳的效果及预后。Objective To explore the complications and preventive measures of modified subtemporal transtentorial approach for resection of petroclival tumors.Method The clinical data of 102 patients with petroclival tumors underwent subtemporal transtentorial approach through straight incision were analyzed retrospectively.Patients were followed up after surgery of the degree of tumor resection and surgical complications.The causes of complications and prevention methods were analyzed.The National Institute of Health Stroke Scale(NIHSS)score and Kamofsky Performance Status(KPS)score were compared between preoperative and postoperative 6 months.Results Of 102 patients,there were 25 meningiomas,52 trigeminal schwannomas,11 chordomas,7 cholesteatomas,4 teratomas and 3 metastatic tumors.The tumor size was(3.2±0.7)cm,with 82 cases of total resection,16 of subtotal resection,and 4 of patial resection.Postoperative follow-up was 6-19 months.The NIHSS and KPS scores of the patients 6 months after surgery were significantly improved compared with those before surgery(all P<0.05).There were 23 patients(23.4%)with different degrees of neurological dysfunction and other complications.After symptomatic treatment and rehabilitation treatment,most of the patients recovered well,and one died.Conclusions The complication rate of resection of tumor in the petroclinal region with subtemporal transtentorial approach is still high.Preoperative comprehensive evaluation should be carried out strictly to achieve individualized treatment,prevent and reduce the occurrence of complications,so as to achieve the best effect and prognosis.

关 键 词：颞下岩前入路 岩斜区肿瘤 并发症 预防 

分 类 号：R739.41[医药卫生—肿瘤]