中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
Chinese Journal of Pediatric Surgery
2015年
10期
749-753
,共5页
孙莲萍%马杰%龚一鸣%金惠明%李奇峰%梁秦川%曹红宾
孫蓮萍%馬傑%龔一鳴%金惠明%李奇峰%樑秦川%曹紅賓
손련평%마걸%공일명%금혜명%리기봉%량진천%조홍빈
颅窝,中%囊肿%外科手术,微创性
顱窩,中%囊腫%外科手術,微創性
로와,중%낭종%외과수술,미창성
Cranial fossa,middle%Cyst%Surgical procedure,mini-invasive
目的 通过对儿童中颅窝底囊肿进行内镜下囊肿-鞍上池造瘘术和术后随访分析,以明确治疗的微创性和疗效.方法 对2007年1月至2013年12月收治的156例中颅窝底囊肿患儿进行回顾性分析,男122例,女34例,平均年龄(52.8±6.6)个月,入选内镜治疗组主要依据头颅MRI显示囊肿内侧为鞍上池,其中左侧104例、右侧46例、双侧6例,依据galassi分级,Ⅰ型3个(为双侧囊肿之一侧)、Ⅱ型87个,Ⅲ型72个.所有患儿接受内镜下囊肿-鞍上池造瘘术.结果 117侧患儿术后平均(10.3±5.1)个月囊肿消失,治愈率72.2％,优良率(囊肿缩小一半以上)为89.5％,有效率(囊肿有缩小)为96.9％,未变化中2例再次手术、1例观察中,术后主要并发症为硬膜下积液,51％于3个月内消失,87.7％于1年内消失,2例行积液-腹腔分流术,7例并发硬膜下血肿行外引流术.发生积液Ⅱ型和Ⅲ型囊肿的年龄、积液的转归与囊肿大小差异均无统计学意义(P＞0.05).结论 神经内镜通过微创锁孔技术进行囊肿和脑池的充分沟通,能缓解囊肿对脑组织局部压迫,改善症状,促进脑发育.对于硬膜下积液者应密切随访,及时发现远期慢性血肿,积极干预后转归满意.
目的 通過對兒童中顱窩底囊腫進行內鏡下囊腫-鞍上池造瘺術和術後隨訪分析,以明確治療的微創性和療效.方法 對2007年1月至2013年12月收治的156例中顱窩底囊腫患兒進行迴顧性分析,男122例,女34例,平均年齡(52.8±6.6)箇月,入選內鏡治療組主要依據頭顱MRI顯示囊腫內側為鞍上池,其中左側104例、右側46例、雙側6例,依據galassi分級,Ⅰ型3箇(為雙側囊腫之一側)、Ⅱ型87箇,Ⅲ型72箇.所有患兒接受內鏡下囊腫-鞍上池造瘺術.結果 117側患兒術後平均(10.3±5.1)箇月囊腫消失,治愈率72.2％,優良率(囊腫縮小一半以上)為89.5％,有效率(囊腫有縮小)為96.9％,未變化中2例再次手術、1例觀察中,術後主要併髮癥為硬膜下積液,51％于3箇月內消失,87.7％于1年內消失,2例行積液-腹腔分流術,7例併髮硬膜下血腫行外引流術.髮生積液Ⅱ型和Ⅲ型囊腫的年齡、積液的轉歸與囊腫大小差異均無統計學意義(P＞0.05).結論 神經內鏡通過微創鎖孔技術進行囊腫和腦池的充分溝通,能緩解囊腫對腦組織跼部壓迫,改善癥狀,促進腦髮育.對于硬膜下積液者應密切隨訪,及時髮現遠期慢性血腫,積極榦預後轉歸滿意.
목적 통과대인동중로와저낭종진행내경하낭종-안상지조루술화술후수방분석,이명학치료적미창성화료효.방법 대2007년1월지2013년12월수치적156례중로와저낭종환인진행회고성분석,남122례,녀34례,평균년령(52.8±6.6)개월,입선내경치료조주요의거두로MRI현시낭종내측위안상지,기중좌측104례、우측46례、쌍측6례,의거galassi분급,Ⅰ형3개(위쌍측낭종지일측)、Ⅱ형87개,Ⅲ형72개.소유환인접수내경하낭종-안상지조루술.결과 117측환인술후평균(10.3±5.1)개월낭종소실,치유솔72.2％,우량솔(낭종축소일반이상)위89.5％,유효솔(낭종유축소)위96.9％,미변화중2례재차수술、1례관찰중,술후주요병발증위경막하적액,51％우3개월내소실,87.7％우1년내소실,2례행적액-복강분류술,7례병발경막하혈종행외인류술.발생적액Ⅱ형화Ⅲ형낭종적년령、적액적전귀여낭종대소차이균무통계학의의(P＞0.05).결론 신경내경통과미창쇄공기술진행낭종화뇌지적충분구통,능완해낭종대뇌조직국부압박,개선증상,촉진뇌발육.대우경막하적액자응밀절수방,급시발현원기만성혈종,적겁간예후전귀만의.
Objective To evaluate the efficacies of endoscopic cystocistemostomy in the treatment of middle fossa cysts (MFC) in children.Methods Retrospective analyses were performed for 156 MFC children from January 2007 to December 2013.There were 122 boys and 34 girls with a mean age of 52.8 ± 6.6 months.All children underwent endoscopic cystocisternostomy according to the brain magnetic resonance imaging (MRI) features of suprasellar cistern medial adjacent to cyst.The cysts were left (n =104),right (n =46) and bilateral (n =6).And their types were Ⅰ (3 cysts,one side of bilateral cases),Ⅱ (87 cysts) and Ⅲ (72 cysts) on the basis of the Galassi classification system.Results During a mean follow-up period of 10.3 ± 5.1 months,cyst disappeared in 114 cases (73.1 ％),shrunk over half in 90.4％ cases and diminished in 96.8％ cases.Two unchanged cysts were reoperated.Subdural hygroma disappeared in 51％ in 3 months and 87.7％ in 12 months.Two cases of subdural hygroma underwent subdural-peritoneal shunt.And 7 cases of subdural hematoma had hemorrhagic drainage.No statistical significance existed between the emergence of subdural hygroma and operative age (P＞0.05) or between cyst fate and cyst size (P＞0.05).Conclusions Adequate communications between cysts and cisterns via a mini-invasive endoscopic fenestration may alleviate cyst compression to brain,improve symptoms and promote brain development.And subdural hygroma and subdural hematoma should be detected timely and watched closely.The prognosis is satisfactory after active interventions.
