CAJ | 학술논문

目的:探讨第四脑室肿瘤显微外科技巧及并发症的防治经验,提高手术的效果.方法:回顾性分析2005年8月至2007年8月68例在湘雅医院经手术治疗的第四脑室肿瘤患者的临床资料.选择小脑蚓部或小脑延髓裂入路切除肿瘤,手术过程中对侵袭延髓呼吸中枢的部分肿瘤不必勉强切除,但均打通导水管下口,关颅时采用颈肌-硬膜悬吊法.结果:肿瘤全切除58例,近全切除10例,本组无死亡病例.术后出现症状性脑积水10例,行脑室-腹腔分流术;原瘤腔出血4例,行二次手术;颅内积气8例,颅内感染10例,上消化道出血18例,均经保守治疗后痊愈.气管切开16例,其中5例呼吸机辅助呼吸,均经治疗后痊愈.本组无枕后皮下积液病例.结论:术中生命中枢的保护及完全打通导水管下口是手术成败的关键,熟练的显微外科技术有助于提高手术疗效,术后积极防治并发症,辅以综合治疗,可改善预后.
목적:탐토제사뇌실종류현미외과기교급병발증적방치경험,제고수술적효과.방법:회고성분석2005년8월지2007년8월68례재상아의원경수술치료적제사뇌실종류환자적림상자료.선택소뇌인부혹소뇌연수렬입로절제종류,수술과정중대침습연수호흡중추적부분종류불필면강절제,단균타통도수관하구,관로시채용경기-경막현조법.결과:종류전절제58례,근전절제10례,본조무사망병례.술후출현증상성뇌적수10례,행뇌실-복강분류술;원류강출혈4례,행이차수술;로내적기8례,로내감염10례,상소화도출혈18례,균경보수치료후전유.기관절개16례,기중5례호흡궤보조호흡,균경치료후전유.본조무침후피하적액병례.결론:술중생명중추적보호급완전타통도수관하구시수술성패적관건,숙련적현미외과기술유조우제고수술료효,술후적겁방치병발증,보이종합치료,가개선예후.
Objective To explore the microneurosurgical technique and prevention of postoper-ative complications for the fourth ventricle tumors in adults. Methods We retrospectively analyzed the clinical data of 68 patients with the fourth ventricle tumors between August 2005 and August 2007 in Xiangya Hospital after microsurgical operation. Tumors were excised by inferior vermis cere-bellar approach or cerebellomedullary fissure approach. The extent of tumor removal should take into consideration the possible injury of brain stem respiratory center, especially tumors adherent to the brain stem. Cerebral aqueduct obstructions were removed in all patients, suspending dura on the neck muscles during closing skull to eliminate scalp hydrops. Results There were 58 total tumor excisions and 10 subtotal tumor excisions. No patient died and no suboccipital hydrops took place before dis-charge in this study. Postoperative symptomatic hydrocephalus was found in 10 patients, but it was cured by ventricle-abdomen shunt. Hemorrhage in tumor lumen happened in 4 patients, who received second microsurgery. Drugs were given to 8 patients with intracranial pneumatocele, 10 with intracra-nial infection, and 18 with upper gastrointestinal hemorrhage. Five patients out of the 16 tracheoto-mies recovered well by mechanical ventilation. Conclusion Protecting the life center of brain stem and dredging the aqueduct outlet completely were the key to surgical success. Therapeutic effect could be improved by adept microneurosurgical techniques after operation. The prognosis of patients may be improved by preventing complications actively and combined therapy after the operation.