CAJ | 학술논문

目的探讨颈静脉孔区肿瘤行显微外科手术治疗的情况及其预后. 方法自1999年1月至2013年12月,对54例颈静脉孔区肿瘤的患者均经Fisch入路行显微手术治疗.术中行肿瘤全切除或近全切除38例,肿瘤大部分切除16例,其中,术后加放疗或γ刀治疗7例.术中全部病例均行面神经监测,行面神经解剖及改道移位35例,面神经“桥梁化”9例,面神经部分切除10例,其中,同期行面神经-舌下神经吻合4例,面神经-耳大神经移植3例. 结果术中41例行外耳道封闭,35例行临近带蒂颞肌瓣术腔填塞,6例行术腔脂肪填塞;术后18例出现不同程度面瘫,其中,14例于术后2周至9个月内不同程度改善,4例未改善;1例术前出现同侧喉返神经麻痹,术后半年好转.术后2例出现皮下血肿,1例出现伤口感染不愈合,经清创缝合及加强抗感染治疗后均好转;2例出现术腔填塞物坏死,经清创换药后好转.随访6个月～5年,除9例有部分肿瘤残留或复发外,其余未见明显复发. 结论 Fisch入路对颈静脉孔区肿瘤行手术治疗具有暴露好、视野清晰、方便止血的优点,术中行面神经监测,必要时可在术中行面神经解剖、“桥梁化”或改道移位,更有利于肿瘤完全或近完全切除,减少神经损伤.术后行术腔填塞及选择性外耳道封闭可有效地减少术腔积液及术后感染的发生率.
목적 탐토경정맥공구종류행현미외과수술치료적정황급기예후. 방법 자1999년1월지2013년12월,대54례경정맥공구종류적환자균경Fisch입로행현미수술치료.술중행종류전절제혹근전절제38례,종류대부분절제16례,기중,술후가방료혹γ도치료7례.술중전부병례균행면신경감측,행면신경해부급개도이위35례,면신경“교량화”9례,면신경부분절제10례,기중,동기행면신경-설하신경문합4례,면신경-이대신경이식3례. 결과 술중41례행외이도봉폐,35례행림근대체섭기판술강전새,6례행술강지방전새;술후18례출현불동정도면탄,기중,14례우술후2주지9개월내불동정도개선,4례미개선;1례술전출현동측후반신경마비,술후반년호전.술후2례출현피하혈종,1례출현상구감염불유합,경청창봉합급가강항감염치료후균호전;2례출현술강전새물배사,경청창환약후호전.수방6개월～5년,제9례유부분종류잔류혹복발외,기여미견명현복발. 결론 Fisch입로대경정맥공구종류행수술치료구유폭로호、시야청석、방편지혈적우점,술중행면신경감측,필요시가재술중행면신경해부、“교량화”혹개도이위,경유리우종류완전혹근완전절제,감소신경손상.술후행술강전새급선택성외이도봉폐가유효지감소술강적액급술후감염적발생솔.
Objective To summarize the condition of surgical treatment and prognosis of 54 cases of jugular foramen tumors in the past 5 years.Methods All 54 cases were treated with operation by Fisch approach.Thirty-eight cases underwent total or near total resection of the tumor.Most resection of the tumor was underwent in 16 cases,in which,7 cases underwent postoperative radiotherapy or gamma knife therapy.The facial nerve monitoring was used in all cases.The facial nerve was anatomized and shifted in 35 cases,was just anatomized like a "bridge" in 10 cases,and was excised partly in 9 cases,in which,4 cases underwent facial-hypoglossal nerve anastomosis and 3 cases underwent transplantation of facial nerve and great auricular nerve.Results The external auditory canal was closed in 41 cases.The near pedicled temporalis muscle flap was obliterated in the operating cavity in 35 cases.Six cases underwent fat filling in the operating cavity.Eighteen patients showed facial palsy in varying degrees after operation.Among them,14 cases improved to different extents in 2 weeks to 9 months and 4 cases did not improve.One case showed recurrent laryngeal nerve paralysis in the same side before operation and improved in half a year after operation.Postoperative subcutaneous hematoma occurred in 2 cases,wound infection in 1 case.All the cases improved by debridement suture and anti-infective therapy.The cavity filling necrosis occurred in 2 cases,which recovered after debridement and dressing.For half a year after operation,except 9 cases of residual or recurrent,and the rest showed no recurrence.Conclusion The Fisch approach of surgical treatment of jugular foramen tumors can provid good exposure,clear vision,facilitate hemostasis.The skills of intraoperative facial nerve monitoring,facial nerve anatomy like a "bridge" or anatomy and shift when necessary are beneficial to the total or nearly total resection of tumor and reduce the injury of facial nerve.The operating cavity filling and selective external auditory canal closure can effectively reduce the surgical cavity effusion and the incidence of postoperative infection.