中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2015年
4期
329-331
,共3页
郝淑煜%薛湛%李达%肖新如%汤劼%王亮%吴震%张力伟%张俊廷
郝淑煜%薛湛%李達%肖新如%湯劼%王亮%吳震%張力偉%張俊廷
학숙욱%설담%리체%초신여%탕할%왕량%오진%장력위%장준정
神经外科手术%颅底肿瘤%再手术
神經外科手術%顱底腫瘤%再手術
신경외과수술%로저종류%재수술
Neurosurgical procedures%Skull base neoplasms%Reoperation
目的 探讨神经外科颅底肿瘤手术后急诊再次开颅手术病例的临床特征.方法 回顾性分析首都医科大学附属北京天坛医院神经外科2008年10月至2013年10月2 500例颅底手术病例中术后再次急诊开颅手术的14例患者,其中颅底脑膜瘤6例,神经鞘瘤3例,垂体腺瘤、颅咽管瘤、骨软骨瘤、血管平滑肌瘤、颈静脉球瘤各1例.第一次手术平均用时9.2h,术中平均出血2 750 ml.再手术的原因由术者和专家组分析得出,并由全科讨论确认.结果 再手术的14例患者中,9例表现为意识减弱,2例术后未能正常苏醒,2例术后常规CT检查发现异常,1例为突发性伤口出血.CT检查发现异常的平均时间为术后17 h,其中瘤腔内出血4例,脑内血肿伴脑挫裂伤4例,大面积脑梗死2例,脑内血肿合并硬膜下血肿l例,硬膜外血肿2例,椎动脉出血1例.再手术后恢复良好6例,中残2例,重残2例,植物生存1例,死亡3例.结论 对于行颅底肿瘤手术的患者,应加强围手术期管理,减少再次手术的发生.
目的 探討神經外科顱底腫瘤手術後急診再次開顱手術病例的臨床特徵.方法 迴顧性分析首都醫科大學附屬北京天罈醫院神經外科2008年10月至2013年10月2 500例顱底手術病例中術後再次急診開顱手術的14例患者,其中顱底腦膜瘤6例,神經鞘瘤3例,垂體腺瘤、顱嚥管瘤、骨軟骨瘤、血管平滑肌瘤、頸靜脈毬瘤各1例.第一次手術平均用時9.2h,術中平均齣血2 750 ml.再手術的原因由術者和專傢組分析得齣,併由全科討論確認.結果 再手術的14例患者中,9例錶現為意識減弱,2例術後未能正常囌醒,2例術後常規CT檢查髮現異常,1例為突髮性傷口齣血.CT檢查髮現異常的平均時間為術後17 h,其中瘤腔內齣血4例,腦內血腫伴腦挫裂傷4例,大麵積腦梗死2例,腦內血腫閤併硬膜下血腫l例,硬膜外血腫2例,椎動脈齣血1例.再手術後恢複良好6例,中殘2例,重殘2例,植物生存1例,死亡3例.結論 對于行顱底腫瘤手術的患者,應加彊圍手術期管理,減少再次手術的髮生.
목적 탐토신경외과로저종류수술후급진재차개로수술병례적림상특정.방법 회고성분석수도의과대학부속북경천단의원신경외과2008년10월지2013년10월2 500례로저수술병례중술후재차급진개로수술적14례환자,기중로저뇌막류6례,신경초류3례,수체선류、로인관류、골연골류、혈관평활기류、경정맥구류각1례.제일차수술평균용시9.2h,술중평균출혈2 750 ml.재수술적원인유술자화전가조분석득출,병유전과토론학인.결과 재수술적14례환자중,9례표현위의식감약,2례술후미능정상소성,2례술후상규CT검사발현이상,1례위돌발성상구출혈.CT검사발현이상적평균시간위술후17 h,기중류강내출혈4례,뇌내혈종반뇌좌렬상4례,대면적뇌경사2례,뇌내혈종합병경막하혈종l례,경막외혈종2례,추동맥출혈1례.재수술후회복량호6례,중잔2례,중잔2례,식물생존1례,사망3례.결론 대우행로저종류수술적환자,응가강위수술기관리,감소재차수술적발생.
Objective To report the clinical features of the patients who underwent emergent recraniotomy after skull base operation.Methods A serial of 14 cases of reoperation after elective surgery in the Department of Neurosurgery,Beijing Tiantan Hospital between October 2008 and October 2013 were reviewed.Six cases were skull basal meningioma,3 schwannoma,1 pituitary adenoma,1 craniopharyngioma,1 chondroma,1 angioleiomyoma,and 1 glomus jugular tumor.The mean length of first operation time was 9.2 h,and the mean amount of bleeding was 2 750 ml.The reason of reoperation was evaluated by the surgeons and experts,and then approved by all doctors.Results The clinical features of these reoperation patients included altered level of consciousness in 9 cases,unrecovered from anesthesia in two,abnormal CT scan in two and one sudden bleeding in wound.The mean time of abnormal CT scan was 17 h.As for the reason for reoperation,the tumor cavity bleeding was found in 4 cases,intracerebral hematoma and brain contusion in 4,massive brain infarction in 2,intracerebral hematoma and subdural hematoma in 1,epidural hematoma in 2,and vertebral artery dissection in 1.Six patients lived a normal life after the second operation,2 moderate disability,2 severe disability,1 persistent vegetative state,and 3 died.Conclusion For skull base surgery,the perioperative management should be reinforced to decrease the emergency reoperation.