中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2013年
24期
60-61
,共2页
霍峻峰%陈小兵%刘献志%翟广
霍峻峰%陳小兵%劉獻誌%翟廣
곽준봉%진소병%류헌지%적엄
松果体区%Poppen入路%静脉间隙%第三脑室后壁
鬆果體區%Poppen入路%靜脈間隙%第三腦室後壁
송과체구%Poppen입로%정맥간극%제삼뇌실후벽
Pineal region%Poppen approach%Vein gaps%Posterior wall of the third ventricule
目的 探讨改良Poppen入路显微手术切除松果体区肿瘤的经验.方法 经改良Poppen入路松果体区肿瘤切除患者30例,归纳和总结术中重要的静脉间隙解剖结构和手术操作要点.结果 肿瘤全切28例,次全切2例.病理结果证实恶性肿瘤22例,良性肿瘤8例.术后并发脑积水加重4例,颅内血肿3例,同向偏盲2例,高热昏迷死亡1例.随访29例,随访时间为2个月～6年,其中Bathel指数评定:生活需要较大帮助(20～40分)2例,生活基本自理(40分～60分)9例,生活完全自理(＞60分)18例.结论 采用改良Poppen入路显微手术切除松果体区肿瘤效果良好,术中小脑幕切迹后间隙的静脉复合体为松果体区,为手术操作的主要阻碍,通过适合的静脉间隙进行显微操作能够完整、安全的将肿瘤切除.第三脑室后壁的打通可能对术后脑积水的改善具有积极作用.
目的 探討改良Poppen入路顯微手術切除鬆果體區腫瘤的經驗.方法 經改良Poppen入路鬆果體區腫瘤切除患者30例,歸納和總結術中重要的靜脈間隙解剖結構和手術操作要點.結果 腫瘤全切28例,次全切2例.病理結果證實噁性腫瘤22例,良性腫瘤8例.術後併髮腦積水加重4例,顱內血腫3例,同嚮偏盲2例,高熱昏迷死亡1例.隨訪29例,隨訪時間為2箇月～6年,其中Bathel指數評定:生活需要較大幫助(20～40分)2例,生活基本自理(40分～60分)9例,生活完全自理(＞60分)18例.結論 採用改良Poppen入路顯微手術切除鬆果體區腫瘤效果良好,術中小腦幕切跡後間隙的靜脈複閤體為鬆果體區,為手術操作的主要阻礙,通過適閤的靜脈間隙進行顯微操作能夠完整、安全的將腫瘤切除.第三腦室後壁的打通可能對術後腦積水的改善具有積極作用.
목적 탐토개량Poppen입로현미수술절제송과체구종류적경험.방법 경개량Poppen입로송과체구종류절제환자30례,귀납화총결술중중요적정맥간극해부결구화수술조작요점.결과 종류전절28례,차전절2례.병리결과증실악성종류22례,량성종류8례.술후병발뇌적수가중4례,로내혈종3례,동향편맹2례,고열혼미사망1례.수방29례,수방시간위2개월～6년,기중Bathel지수평정:생활수요교대방조(20～40분)2례,생활기본자리(40분～60분)9례,생활완전자리(＞60분)18례.결론 채용개량Poppen입로현미수술절제송과체구종류효과량호,술중소뇌막절적후간극적정맥복합체위송과체구,위수술조작적주요조애,통과괄합적정맥간극진행현미조작능구완정、안전적장종류절제.제삼뇌실후벽적타통가능대술후뇌적수적개선구유적겁작용.
Objective To investigate the experience of microsurgical anatomy in resection of the pineal region tumors through the modified poppen approach.Methods The clinical data of 30 patients with tumor in the pineal region resected by microsurgery through modified Poppen approach were analyzed retrospectively,and the key anatomic gaps between the veins in the region and the key operation points in the surgical procedure were summarized.Results The total tumor removal was achieved in 28 cases,subtotal removal in 2 cases.The tumors were benign in 22 patients and malignant in 8 cases,which were confirmed by biopsy.Hydrocephalus aggravated in 4 cases,and intracranial hematoma occurred in 3 cases,and homonymous hemianopia presented in 3 cases,and one died of high temperature and coma.Twentynine patients were followed up for 2 month to 6 years.According to Bathel index,18 cases acquired scores above 60,9 cases acquired scores between 40 and 60,and 2 cases acquired scores between 20 and 40.Conclusions The effect of microsurgery in resection of the tumor in the pineal region through modified Poppen approach is good.Veins complex in the posterior gap of tentorial notch is the main barrier in the surgical procedure,but the rumor can be resected totally and safely through proper vein gap.Intraoperative fistulization on the posterior wall of the third ventricule may play an active role in improving postoperative hydrocephalus.
