两种术式治疗颅内蛛网膜囊肿35例体会  

Experience of two kinds of operation for intracranial arachnoid cyst

作　　者：左德献 李正阳 罗似亮 吾太华 马赞 邓少勇 许锡镇 ZUO Dexian;LI Zhengyang;LUO Siliang;WU Taihua;MA Zan;DENG Shaoyong;XU Xizhen(Department of neurosurgery,Guang Dong 999 Brain Hospital,Guangzhou,Guangdong,510510,China)

机构地区：[1]广东三九脑科医院神经外科,广东广州510510

出　　处：《当代医学》2021年第36期20-22,共3页Contemporary Medicine

摘　　要：目的探讨颅内蛛网膜囊肿的手术方式及疗效。方法选取2011年1月至2016年11月于本院神经外科明确囊肿诊断,接受手术治疗的35例囊肿患者作为研究对象,根据患者囊肿部位、大小、解剖学及影像学特点分为A组与B组。A组采用囊肿-腹腔分流术,B组采用囊肿切除联合囊肿-脑池-蛛网膜下腔穿通术,分析两组手术疗效及并发症发生情况。结果患者均通过门诊随访6个月~5年,症状消失23例,症状减轻9例,智力障碍无改善3例。复查颅脑CT显示囊肿消失8例,近于消失(囊肿缩小>80%)9例,明显缩小(囊肿缩小>50%)15例,无变化3例;4例并脑积水均有不同程度缓解。两组共发生并发症6例,其中A组分流管断裂坠入盆腔1例,分流管外露并局部感染1例,肠穿孔2例,化脓性胆囊炎1例;B组颅内感染1例。结论根据囊肿的解剖学和影像学特点,个体化选择手术方式是提高疗效的关键,囊肿-腹腔分流效果确切,但并发症发生率较高,需严格掌握手术适应证。Objective To explore operative kinds and effect of intracranial arachnoid cyst(IAC).Methods Selected 35 patients with cysts who received surgical treatment from January 2011 to November 2016 to confirm the diagnosis of cysts in our hospital.According to the location,size,anatomy and imaging characteristics of the cysts,they were divided into group A and group B.Group A used cyst-peritoneal shunt,group B used cyst resection and cyst-cistern-subarachnoid perforation,and analyzed the surgical efficacy and complications between the two groups.Results The patients were followed up for 6 months to 5 years through the outpatient clinic.The symptoms disappeared in 23 cases,the symptoms were relieved in 9 cases,and the mental retardation was not improved in 3 cases.Re-examination of brain CT showed that 8 cases of cyst disappeared,9 cases were nearly disappeared(cyst reduction>80%),15 cases were significantly reduced(cyst reduction>50%),and 3 cases were unchanged;4 cases had different degrees of hydrocephalus ease.Complications occurred in 6 cases in the two groups,including 1 case with component A flow tube rupture and falling into the pelvic cavity,1 case with shunt tube exposure and local infection,2 cases with intestinal perforation,1 case with suppurative cholecystitis;1 case with intracranial infection in group B.Conclusion According to the anatomical and imaging characteristics of the cyst,the individualized selection of surgery is the key to improve the efficacy,the cyst-peritoneal shunt effect is accurate,but the incidence of complications is high,and the surgical indications must be strictly mastered.

关 键 词：颅内蛛网膜囊肿 影像学 囊肿-腹腔分流术 手术方式 

分 类 号：R651.1[医药卫生—外科学]