神经内镜下手术治疗儿童小脑肿瘤30例临床分析  

Clinical analysis of neuroendoscopic surgery for 30 children with cerebellar tumors

作　　者：刘昉 张晓华[2] 王俊[3] 陈卓 安妮妮 谭赢 曾宇 刘建 刘军 傅俊武 戴珂 王超 Liu Fang;Zhang Xiaohua;Wang Jun;Chen Zhuo;An Nini;Tan Ying;Zeng Yu;Liu Jian;Liu Jun;Fu Junwu;Dai Ke;Wang Chao(Department of Neurosurgery,Guizhou Hospital of Shanghai Children′s Medical Center,Guiyang 550002,China;Department of Neurosurgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200120,China;Department of Neurosurgery,Guizhou Provincial People′s Hospital,Guiyang 550002,China;Department of Neurosurgery,the Affiliated Hospital of Guizhou University,Guiyang 550002,China;Department of Neurosurgery,the Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China)

机构地区：[1]上海儿童医学中心贵州医院神经外科,贵阳550002 [2]上海交通大学医学院附属仁济医院神经外科,上海200120 [3]贵州省人民医院神经外科,贵阳550002 [4]贵州大学附属医院神经外科,贵阳550002 [5]遵义医科大学附属医院神经外科,遵义563000

出　　处：《中华实用儿科临床杂志》2024年第8期589-591,共3页Chinese Journal of Applied Clinical Pediatrics

基　　金：贵州省科技厅(黔科合LH字(2016)7168);贵州省人民医院博士基金(GZSYBS(2018)03,GZSYBS(2018)06)。

摘　　要：目的探讨神经内镜在小脑肿瘤切除中的应用价值及手术经验。方法病例系列研究。回顾性分析2021年1月至2024年1月上海儿童医学中心贵州医院、贵州省人民医院神经外科同一治疗组采用神经内镜下治疗的小脑肿瘤患儿临床资料,共30例,分析其临床资料及疗效。结果全切除26例,次全切除3例,活检1例。术后病理检查结果:髓母细胞瘤9例,室管膜瘤3例,星型胶质细胞瘤17例(世界卫生组织Ⅰ5例、Ⅱ3例、Ⅲ9例);活检病例为小脑良性病变。并发症:围术期发生恶性心律失常死亡1例,小脑性缄默12例,共济失调22例;术后随访1~36个月,出现交通性脑积水2例,分别在术后2、6个月行脑室腹腔分流术后脑积水改善;术后(115±23)d(46~194 d)小脑性缄默均有不同程度的改善,共济失调术后(127±42)d(27~173 d)好转;末次随访:肿瘤复发5例。结论熟练操作者术中使用神经内镜在小脑蚓部肿瘤的外科切除中能达到显露要求,提供了显微镜外的另一个选择。Objective To explore the application value and surgical experience of neuroendoscopic resection for pediatric patients with cerebellar tumors.Methods This was a case series study.The clinical data and outcomes of 30 pediatric patients with cerebellar tumors treated through neuroendoscopic surgery in the Department of Neurosurgery,the Guizhou Hospital of Shanghai Children′s Medical Center and Guizhou Provincial People′s Hospital from January 2021 to January 2024 were retrospectively analyzed.Results Twenty-six patients underwent total resection,3 patients underwent subtotal resection,and 1 patient underwent biopsy.Postoperative pathological findings showed 9 cases of medulloblastoma,3 cases of ependymoma,17 cases of astrocytoma(5 cases of World Health Organization GradeⅠ,3 cases of GradeⅡ,and 9 cases of GradeⅢ),and 1 case of cerebellar benign lesion.During the perioperative period,malignant arrhythmia occurred and induced death in 1 case,cerebellar mutism occurred in 12 cases,and ataxia occurred in 22 cases.During the 1-36 months of follow-up,2 cases developed communicating hydrocephalus at the 2 nd and the 6 th month,respectively,and improved after ventriculoperitoneal shunt;cerebellar mutism was relieved to varying degrees after an average postoperative follow-up period of(115±23)days(46-194 days),and ataxia was alleviated after an average postoperative follow-up period of(127±42)days(27-173 days).Tumors relapsed in 5 cases during the last follow-up.Conclusions Neuroendoscopy provides an alternative to the microscope for experienced operators to achieve the surgical exposure requirements during the resection of pediatric cerebellar vermis tumors.

关 键 词：儿童 小脑肿瘤 神经内镜 

分 类 号：R739.4[医药卫生—肿瘤]