CAJ | 학술논문

目的探讨立体定向手术治疗颅内囊性病变的手术方法、有效性及优点. 方法回顾性分析北京军区总医院神经外科自2002年12月至2009年11月采用立体定向手术治疗的29例颅内囊性病变患者(病灶37个)的临床资料,其中颅咽管瘤11例,胶质瘤5例,转移瘤3例,脑脓肿10例.18例肿瘤患者行Ommaya囊置入及32P内放疗[32内放疗剂量根据囊性病变体积,平均为800 μCi(500～1500 μCi)],1例单纯抽液后外放疗;10例脑脓肿患者置管引流8例,穿刺冲洗2例.结果本组无手术出血及死亡患者.患者随访1～60月,平均10.6月,4例因无法联系而失访.11例颅咽管瘤患者(病灶11个)经32P内放疗症状稳定无复发.8例其他肿瘤患者(病灶12个)中有5例控制症状5～48月,3例无效(转移瘤2例,胶质母细胞瘤1例).10例脑脓肿患者(病灶14个)经穿刺引流症状消失治愈.2例颅咽管瘤患者32P内放疗后出现一过性尿崩、低热及呕吐. 结论立体定向手术对于脑脓肿、囊性颅咽管瘤、体积不大的深部胶质瘤及转移瘤而言,较传统开颅手术具有明显的优势,但对体积较大、难于短期控制瘤液分泌的囊性转移瘤效果不佳.
목적 탐토입체정향수술치료로내낭성병변적수술방법 、유효성급우점. 방법 회고성분석북경군구총의원신경외과자2002년12월지2009년11월채용입체정향수술치료적29례로내낭성병변환자(병조37개)적림상자료,기중로인관류11례,효질류5례,전이류3례,뇌농종10례.18례종류환자행Ommaya낭치입급32P내방료[32내방료제량근거낭성병변체적,평균위800 μCi(500～1500 μCi)],1례단순추액후외방료;10례뇌농종환자치관인류8례,천자충세2례.결과 본조무수술출혈급사망환자.환자수방1～60월,평균10.6월,4례인무법련계이실방.11례로인관류환자(병조11개)경32P내방료증상은정무복발.8례기타종류환자(병조12개)중유5례공제증상5～48월,3례무효(전이류2례,효질모세포류1례).10례뇌농종환자(병조14개)경천자인류증상소실치유.2례로인관류환자32P내방료후출현일과성뇨붕、저열급구토. 결론 입체정향수술대우뇌농종、낭성로인관류、체적불대적심부효질류급전이류이언,교전통개로수술구유명현적우세,단대체적교대、난우단기공제류액분비적낭성전이류효과불가.
Objective To explore the methods, efficacy and advantages ofstereotactic surgery.Methods A retrospective analysis of 29 consecutive patients with 37 lesions (mean age, 34.6 years),received surgery between Dec 2002 and Nov 2009, was performed. Histological findings showed 11 craniopharyngiomas, 5 cystic gliomas, 3 metastases and 10 cerebral abscesses. Eighteen patients underwent cyst aspiration by the Ommaya reservoir system combined with 32P endocavitary irradiation;median irradiation doses were 800 μCi. One was treated with aspiration and then radiotherapy only. Ten patients with cerebral abscesses received cystic drainage (8 cases) and aspiration (2 cases). Results No operative bleeding and death were found in this experiment. Follow up was performed for a median of 10.6 months (range, 1-60 months) and 4 were out of contact. All patients with craniopharyngiomas remained stable without recurrence after treatment; complete resolution was achieved in all patients with cerebral abscess; in the other 8 patients with tumors(12 lesions), 5 were under control of the symptoms for an average of 14 months and 3 (2 with metastases and 1 with glioblastoma) did not get improvement after the treatment. Two patients with craniopharyngioma experienced a transient slightly worsening of hypothalamic functions, including transient diabetes insipidus, low fever and vomit. Conclusion Stereotactic technique has its advantages in treating patients with cerebral abscess, craniopharyngiomas,metastatic tumors and gliomas that were small size, while it does not that effective in the cystic metastases that are in large size and difficult to control in a short term.