中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2015年
9期
907-911
,共5页
脑膜瘤%上矢状窦%神经外科手术
腦膜瘤%上矢狀竇%神經外科手術
뇌막류%상시상두%신경외과수술
Meningioma%Superior sagittal sinus%Neurosurgical procedures
目的 探讨有效切除上矢状窦中1/3窦旁脑膜瘤的方法以便提高其临床疗效,并降低术后并发症.方法 通过采用患侧卧位并尽可能保留上矢状窦和引流静脉的前提下行肿瘤相对保守的切除策略,当肿瘤残留明显或随访期间肿瘤进展则给予辅助放射治疗,最后对手术疗效及其术后并发症等临床资料进行统计学分析.结果 124例患者中96例(77.4％)获得全切除,28例(22.6％)大部切除.术后随访6～60个月,复发13例(10.5％),其中男4例(9.3％),女9例(12.2％),全切除患者复发9例(9.4％),次全切除患者复发4例(14.3％),复发率在不同性别之间差异无统计学意义(P＞0.05),全切除患者与次全切除患者之间复发率差异无统计学意义(P＞0.05).术后120患者恢复良好并参加工作,2例(1.6％)致残,但可生活自理,2例(1.6％)死亡,1例死于肺栓塞,1例死于心肌梗死.结论 采用患侧卧位和显微外科技术有利于切除肿瘤的同时保护引流静脉和大脑皮层,尽可能保留通畅的上矢状窦和引流静脉可降低术后致死致残率,必要时术后加用放射治疗也可取得良好的远期疗效.
目的 探討有效切除上矢狀竇中1/3竇徬腦膜瘤的方法以便提高其臨床療效,併降低術後併髮癥.方法 通過採用患側臥位併儘可能保留上矢狀竇和引流靜脈的前提下行腫瘤相對保守的切除策略,噹腫瘤殘留明顯或隨訪期間腫瘤進展則給予輔助放射治療,最後對手術療效及其術後併髮癥等臨床資料進行統計學分析.結果 124例患者中96例(77.4％)穫得全切除,28例(22.6％)大部切除.術後隨訪6～60箇月,複髮13例(10.5％),其中男4例(9.3％),女9例(12.2％),全切除患者複髮9例(9.4％),次全切除患者複髮4例(14.3％),複髮率在不同性彆之間差異無統計學意義(P＞0.05),全切除患者與次全切除患者之間複髮率差異無統計學意義(P＞0.05).術後120患者恢複良好併參加工作,2例(1.6％)緻殘,但可生活自理,2例(1.6％)死亡,1例死于肺栓塞,1例死于心肌梗死.結論 採用患側臥位和顯微外科技術有利于切除腫瘤的同時保護引流靜脈和大腦皮層,儘可能保留通暢的上矢狀竇和引流靜脈可降低術後緻死緻殘率,必要時術後加用放射治療也可取得良好的遠期療效.
목적 탐토유효절제상시상두중1/3두방뇌막류적방법이편제고기림상료효,병강저술후병발증.방법 통과채용환측와위병진가능보류상시상두화인류정맥적전제하행종류상대보수적절제책략,당종류잔류명현혹수방기간종류진전칙급여보조방사치료,최후대수술료효급기술후병발증등림상자료진행통계학분석.결과 124례환자중96례(77.4％)획득전절제,28례(22.6％)대부절제.술후수방6～60개월,복발13례(10.5％),기중남4례(9.3％),녀9례(12.2％),전절제환자복발9례(9.4％),차전절제환자복발4례(14.3％),복발솔재불동성별지간차이무통계학의의(P＞0.05),전절제환자여차전절제환자지간복발솔차이무통계학의의(P＞0.05).술후120환자회복량호병삼가공작,2례(1.6％)치잔,단가생활자리,2례(1.6％)사망,1례사우폐전새,1례사우심기경사.결론 채용환측와위화현미외과기술유리우절제종류적동시보호인류정맥화대뇌피층,진가능보류통창적상시상두화인류정맥가강저술후치사치잔솔,필요시술후가용방사치료야가취득량호적원기료효.
Objective To investigate the methods of effective removal of the middle third parasagittal meningioma in order to improve its clinical efficacy and decrease the postoperative complications.Methods The tumors were resected with a relatively conservative strategy by using lateral supine and preserved the superior sagittal sinus and draining veins as much as possible.When tumor residues were obvious and progressive during the follow-up period,they were given adjuvant radiation therapy.Finally,the clinical data including surgical effect and postoperative complications were analyzed statistically.Results Of the 124 patients,96 (77.4％) achieved total resection;28 (22.6％) achieved subtotal resection.They were followed up for 6 to 60 months after procedure,13 (10.5％) had recurrence,including 9 females (12.2％) and 4 males (9.3％).Nine patients (9.4％) of total resection had recurrence,4 (14.3％) of total resection had recurrence.There was no significant difference in the recurrence rate between the different genders (P ＞ 0.05).There was no significant difference in the recurrence rate between the patients of total resection and those of subtotal resection (P ＞ 0.05).After procedure,120 patients recovered well and returned to work.Two (1.6％) had disability,but they could take care of themselves.Two patients (1.6％) died,one died of pulmonary embolism and the other died of myocardial infarction.Conclusions Using lateral supine and microsurgical techniques are conducive to the resection of tumors while protecting the draining veins and cerebral cortices.Preserving the patency of the superior sagittal sinus and draining vein as much as possible may reduce the postoperative mortality and disability.If necessary,using radiotherapy after procedure can also achieve good long-term efficacy.
