中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2014年
3期
191-195
,共5页
张治华%汪照炎%黄琦%杨军%吴皓
張治華%汪照炎%黃琦%楊軍%吳皓
장치화%왕조염%황기%양군%오호
神经瘤,听%耳外科手术%手术中并发症%手术后并发症
神經瘤,聽%耳外科手術%手術中併髮癥%手術後併髮癥
신경류,은%이외과수술%수술중병발증%수술후병발증
Neuroma,acoustic%Otologic surgical procedures%Intraoperative complications%Postoperative complications
目的 通过分析大型听神经瘤的手术效果,总结其治疗经验.方法 收集2001年1月至2012年12月共134例大型听神经瘤患者的临床资料,回顾分析其肿瘤大小、是否囊性变、手术径路、肿瘤切除范围、面神经解剖保留率、术后面神经功能以及并发症等指标.结果 129例(96.3％)患者在初次诊断或确诊复发后1个月内、院手术,5例(3.7％)患者于初诊后1年复查MRI示肿瘤仍有进行性增大后入院手术.肿瘤直径31.0 ～70.0 mm,平均(40.9±6.8)mm(x±s),囊性变比例35.1％(47/134).手术径路包括扩大迷路径路118例[88.1％,其中16例(11.9％)为改良扩大迷路径路],耳囊径路16例(11.9％).肿瘤全切、近全切、次全切除率分别为91.0％(122/134),6.7％ (9/134)和2.2％(3/134).术中面神经解剖保留率达88.8％(119/134),其中囊性听神经瘤面神经解剖保留率(80.9％,38/47)明显低于实性囊性听神经瘤(93.1％,81/87),差异具有统计学意义(P=0.044).术后近期面神经功能良好率为32.3％(43/133),远期达36.8％(49/133).并发症总发生率为17.9％(24/134),其中脑脊液漏发生率为7.5％(10/134);死亡率为0.7％(1/134);术后随访1～5年,平均随访(2.7±0.4)年,4例出现复发.结论 大型听神经瘤治疗策略以手术为主,即使暂时不行手术,亦应定期观察,尽早手术.虽然手术切除安全可靠,死亡率和并发症率均较低,但术前仍应详尽告知患者术后可能存在的风险.肿瘤囊性变是影响手术效果(特别是术后面神经功能)的重要因素.
目的 通過分析大型聽神經瘤的手術效果,總結其治療經驗.方法 收集2001年1月至2012年12月共134例大型聽神經瘤患者的臨床資料,迴顧分析其腫瘤大小、是否囊性變、手術徑路、腫瘤切除範圍、麵神經解剖保留率、術後麵神經功能以及併髮癥等指標.結果 129例(96.3％)患者在初次診斷或確診複髮後1箇月內、院手術,5例(3.7％)患者于初診後1年複查MRI示腫瘤仍有進行性增大後入院手術.腫瘤直徑31.0 ～70.0 mm,平均(40.9±6.8)mm(x±s),囊性變比例35.1％(47/134).手術徑路包括擴大迷路徑路118例[88.1％,其中16例(11.9％)為改良擴大迷路徑路],耳囊徑路16例(11.9％).腫瘤全切、近全切、次全切除率分彆為91.0％(122/134),6.7％ (9/134)和2.2％(3/134).術中麵神經解剖保留率達88.8％(119/134),其中囊性聽神經瘤麵神經解剖保留率(80.9％,38/47)明顯低于實性囊性聽神經瘤(93.1％,81/87),差異具有統計學意義(P=0.044).術後近期麵神經功能良好率為32.3％(43/133),遠期達36.8％(49/133).併髮癥總髮生率為17.9％(24/134),其中腦脊液漏髮生率為7.5％(10/134);死亡率為0.7％(1/134);術後隨訪1～5年,平均隨訪(2.7±0.4)年,4例齣現複髮.結論 大型聽神經瘤治療策略以手術為主,即使暫時不行手術,亦應定期觀察,儘早手術.雖然手術切除安全可靠,死亡率和併髮癥率均較低,但術前仍應詳儘告知患者術後可能存在的風險.腫瘤囊性變是影響手術效果(特彆是術後麵神經功能)的重要因素.
목적 통과분석대형은신경류적수술효과,총결기치료경험.방법 수집2001년1월지2012년12월공134례대형은신경류환자적림상자료,회고분석기종류대소、시부낭성변、수술경로、종류절제범위、면신경해부보류솔、술후면신경공능이급병발증등지표.결과 129례(96.3％)환자재초차진단혹학진복발후1개월내、원수술,5례(3.7％)환자우초진후1년복사MRI시종류잉유진행성증대후입원수술.종류직경31.0 ～70.0 mm,평균(40.9±6.8)mm(x±s),낭성변비례35.1％(47/134).수술경로포괄확대미로경로118례[88.1％,기중16례(11.9％)위개량확대미로경로],이낭경로16례(11.9％).종류전절、근전절、차전절제솔분별위91.0％(122/134),6.7％ (9/134)화2.2％(3/134).술중면신경해부보류솔체88.8％(119/134),기중낭성은신경류면신경해부보류솔(80.9％,38/47)명현저우실성낭성은신경류(93.1％,81/87),차이구유통계학의의(P=0.044).술후근기면신경공능량호솔위32.3％(43/133),원기체36.8％(49/133).병발증총발생솔위17.9％(24/134),기중뇌척액루발생솔위7.5％(10/134);사망솔위0.7％(1/134);술후수방1～5년,평균수방(2.7±0.4)년,4례출현복발.결론 대형은신경류치료책략이수술위주,즉사잠시불행수술,역응정기관찰,진조수술.수연수술절제안전가고,사망솔화병발증솔균교저,단술전잉응상진고지환자술후가능존재적풍험.종류낭성변시영향수술효과(특별시술후면신경공능)적중요인소.
Objective To analyze the surgical outcomes and share experience in the surgical management of acoustic neuroma(AN).Methods A retrospective review was performed in 134 patients with sporadic large ANs operated from Jan.2001 to Dec.2012.The patients' information,tumor size,tumor cystic degeneration,surgical approach,intraoperative anatomical facial nerve integrity rate,postoperative facial nerve function and complications were recorded.Results There were one hundred and twenty-nine patients (96.3％) received surgeries within one month after first diagnosis of vestibular schwannoma(VS) or definite diagnosis of recurrence.Five patients (3.7％) hesitated to be operated until tumor was found to be growing on MRI during the follow-up.The average tumor diameter was about (40.9 ± 6.8) mm (31.0 ～ 70.0 mm).The cystic tumor percentage arrived at 35.1％ (47/134).The surgical approaches included 118 (88.1％) translabyrinthine approaches,comprising 16 (11.9％) modified enlarged translabyrinthine approaches,and 16 (11.9％) transotic approaches.Total,near total,and subtotal tumor removal rate was 91.0％ (122/134),6.7％ (9/134) and 2.2％ (3/134),respectively.The anatomical facial nerve integrity was preserved in 88.8％ (19/134) of all patients.And it was significantly lower in cystic VS (80.9％ vs 93.1％,P =0.044).There were 32.3％ (43/133) and 36.8％ (49/133) of patients had a good postoperative facial nerve function in short-term (discharge from hospital) and long-term (1 year) followup,respectively.General rate of complications was 17.9％ (24/134).CSF leakage occurred in 7.5％ of patients.Mortality rate was 0.7 ％ (1/134).Follow-up time ranged from 1 to 5 years,average time was (2.7 ±0.4) years.Four cases ocourred recurrence.Conclusions Major management strategy of large AN is surgicalresection.Even for those who had temporary antagonism for surgery,the wait and scan policy is necessary.Although the tumor removal is safe and accompanies extremely low mortality and incidence of complication,the patient with large AN must be informed in detail about the possible surgical risks.The tumor cystic degeneration is an important crucial factor which influences the surgical outcomes of AN,especially in postoperative facial nerve function.
