显微外科手术治疗颅咽管瘤95例预后分析

目的探讨颅咽管瘤显微手术治疗的方法选择及影响患者预后的相关因素。方法回顾性分析2008年1月至2013年6月中国医科大学附属第一医院收治的95例颅咽管瘤患者临床资料,均行显微外科手术治疗。随访并评估生存质量。结果肿瘤全切除70例,次全切除15例,部分切除10例。最常见的术后并发症为垂体功能低下及尿崩。术后随访8个月至5年,死亡16例(16.8%),复发14例。性别和切除程度是影响术后5年生存率的危险因素。结论采用显微外科手术全切颅咽管瘤,5年生存率较高,且复发率较低。     

颅咽管瘤显微手术治疗及疗效分析

 目的 探讨颅咽管瘤的显微手术方法及疗效。方法 回顾性分析武警总医院2010-01至2014-12收治的136例颅咽管瘤患者的临床资料。手术均在显微镜下进行,其中采用额底纵裂入路42例,额下入路28例,胼胝体穹窿间入路27例,翼点入路36例,经蝶窦入路3例。结果 本组肿瘤全切除118例,次全切除14例,大部分切除4例。术后出现尿崩症63例(暂时性尿崩症42例),视力下降或失明28例,电解质紊乱65例。其他并发症:中枢性高热8例,动眼神经损伤3例,脑梗死1例,颅内感染2例。术后1个月内出现死亡3例,死因均为下丘脑综合征。因病情危重或经济原因放弃治疗办理自动出院3例。结论 根据肿瘤的生长部位、比邻关系和生长方式,合理地选择手术入路是颅咽管瘤手术成功的关键。     

复发性颅咽管瘤的原因分析和治疗进展

颅咽管瘤是一种常见的先天性良性肿瘤,其治疗效果欠满意,复发率较高,是神经外科的难题之一。颅咽管瘤的复发原因很多,与手术前症状、肿瘤病理类型、手术全切和术后放疗有关。复发性颅咽管瘤的治疗方法包括外科切除、立体定向放射治疗和立体定向内化疗,它们各有优缺点,若能联合应用、取长补短,则对某些复发颅咽管瘤可以进行有效的治疗,提高肿瘤控制率和生存率,减少治疗相关致残率、病死率。     

经鼻蝶手术经路切除颅咽管瘤

经鼻蝶手术经路切除颅咽管瘤７１００３２西安第四军医大学西京医院章翔付洛安易声禹费舟张剑宁张志文李安民刘卫平关键词颅咽管瘤；经蝶手术；治疗中国图书资料分类号Ｒ６１５．１５颅咽管瘤是一种较常见的胚胎残余组织肿瘤，对本病的传统治疗方法一般采取经颅入路手术切...     

关于颅咽管瘤手术原则的临床病理研究

长期以来,认为手术切除是颅咽管瘤较理想的治疗措施。然而,“全部”切除肿瘤会引起严重的神经内分泌并发症,而且手术后易于复发,都是神经外科医生感到棘手的问题。为此,本文根据7例尸检材料的病理学研究与15例经手术广泛切除的临床分析,探讨颅咽管瘤手术切除的可能性,以及影响预后的一些有关问题。根据7例尸检与15例手术所见,发现颅咽管瘤的瘤体可为囊性(10例)、实质性(6例)、及混合型(6例)。肿瘤的容积2～55毫升不等。瘤体较大者(容积大于30毫升),可向第三脑室发展,并可侵及丘脑。组织学检查发现:囊性颅咽管瘤的     

复发性囊性颅咽管瘤CT引导立体定向埋囊引流治疗

复发性囊性颅咽管瘤ＣＴ引导立体定向埋囊引流治疗７１００３２西安第四军医大学西京医院王占祥章翔张剑宁李安民费舟张志文付洛安刘卫平关键词立体定位技术；颅咽管瘤；脑肿瘤；引流中国图书资料分类号Ｒ７３９．４１颅咽管瘤是颅内常见的肿瘤之一，尽管显微手术技术有了...     

接触式Nd∶YAG激光在颅内肿瘤手术中的应用

目的总结采用新型接触式Ｎｄ∶ＹＡＧ激光进行颅内肿瘤切除的临床效果。方法２８例患者中脑膜瘤１４例、星形细胞瘤５例、听神经瘤４例、颅咽管瘤和髓母细胞瘤各２例、室管膜瘤１例。Ｓｔｏｒｚ内镜下激光手术３例，显微镜下激光手术４例，直视下激光手术２１例。接触式Ｎｄ∶ＹＡＧ激光波长１０６４μｍ，输出功率０～１００Ｗ。瘤周分离用尖探头，激光功率５～１５Ｗ；瘤内汽化用圆探头，激光功率一般３０～６０Ｗ，脑室内２０～４０Ｗ。结果除１例中颅凹底脑膜瘤、１例蝶骨嵴脑膜瘤和１例丘脑星形细胞瘤作次全切除外，其余均行肿瘤全切除，肿瘤手术全切率为８９％。术中输血２００～１２００ｍｌ（中位数为６００ｍｌ）。无手术死亡病例。术后２例出现轻偏瘫，１例出现轻面瘫，１例低热，占１４％。结论接触式Ｎｄ∶ＹＡＧ激光用于颅内肿瘤，尤其是脑深部和重要功能区肿瘤的切除，可提高切除率，减少手术死亡率和后遗症，值得临床推广。     

延脊髓型脑干肿瘤的诊断和显微手术切除

目的 探讨延脊髓型脑干肿瘤的诊断和显微手术治疗效果。方法 16例患者经MRI诊断为延脊髓型脑干肿瘤。采用小脑延髓裂入路,于显微镜下手术切除病变及康复治疗。结果 12例肿瘤达全切除,3例获次全切除,1例为部分切除。瘤标本经病理学检查分别为星形细胞瘤、胶质母细胞瘤、血管网状细胞瘤。临床痊愈出院11例,好转出院4例,死亡1例。结论 MRI是诊断延脊髓型脑干肿瘤的最佳检查方法 ,采用显微手术治疗此类肿瘤,尽可能多的切除肿瘤,减少并发症,达到解除症状及延长生命的目的 ,手术效果良好。同时长期有效的后期康复治疗也很重要。     

颅咽管瘤的CT诊断（附50例分析）

颅咽管瘤是常见的鞍区肿瘤之一．国内外已有众多报道，作者收集手术病理证实的50例颅咽管瘤，旨在进一步探讨囊实性颅咽管瘤的囊性部分与实性部分的分布及各种倾咽管痛的钙化形态等特征性改变。资料与方法：本组收集手术病理证实的颅咽管瘤50例，男性29例，女性21例，年龄4～57     

改良翼点入路显微直视手术切除海绵窦肿瘤

为总结海绵窦肿瘤显微神经外科治疗的经验，作者对1990年1月－2001年6月收治的26例海绵窦肿瘤病例进行了回顾性分析。手术均采用改良翼点入路，显微直视手术，其中6例在神经导航辅助下进行。结果全切19例（73.1%)部分切除7例（26.9%)。术后14例（53.8%)颅神经症状逐渐改善，6例（23.1%)出现新的颅神经损害症状，无死亡。对部分切除的病人，术后加立体定向放射外科治疗。随访8个月－12年，未见肿瘤复发。作者认为，熟悉海绵窦区的显微解剖并具备熟练的显微神经外科技术，可使该类手术取得良好效果。     

神经导航显微手术联合光动力疗法治疗功能区脑胶质瘤

目的探讨神经导航显微手术联合光动力疗法（PDT）治疗功能区脑胶质瘤的安全性及有效性。方法将65例功能区胶质瘤患者分为两组,治疗组40例经神经导航指引下进行显微手术切除病灶,然后根据瘤床的结构和形状对瘤腔进行PDT治疗;对照组25例单纯行神经导航显微手术切除病灶。治疗后第8周和第12周行CT、MRI检查观察两组患者术后肿瘤坏死、水肿带减轻、残留肿瘤体积等变化,并观察神经功能缺失情况。结果治疗后8周和12周治疗组和对照组出现新的神经功能缺失率分别为2.5%、5.0%和7.5%、12.0%。影像学显示治疗组肿瘤坏死,水肿带减轻31例,8例残留肿瘤体积明显缩小;对照组水肿带减轻15例,4例术后残留肿瘤体积无变化。结论神经导航显微手术联合PDT疗法治疗功能区脑胶质瘤,能够有效抑制肿瘤生长,并能使残留肿瘤体积缩小,减少神经功能缺失,在减缓出现新的神经功能缺失和改善患者生活质量方面具有一定优势。     

腹腔镜超声在腹腔镜胰岛素瘤切除术中的定位诊断

目的 探讨腹腔镜超声在胰岛素瘤腹腔镜术中的定位诊断价值.资料与方法 回顾性分析64例行腹腔镜胰岛素瘤切除术患者的手术结果,计算术中超声对胰岛素瘤的检出率及定位诊断准确率,并评价术中超声引导下胰岛素瘤切除术的效果.结果 64例患者中,62例行腹腔镜胰岛素瘤切除术,2例因术中超声检查未发现明确肿瘤而未行任何手术.术中超声对肿瘤的检出率为96.9％,共检出69个结节,其对肿瘤个数的定位诊断准确率为100％.62例腹腔镜术中超声明确胰岛素瘤的患者中,59例单发肿瘤患者行腹腔镜单纯胰岛素瘤摘除术;3例多发肿瘤患者肿瘤结节均位于胰腺体尾部,其中1例行腹腔镜超声检查后直接转开腹手术,其余2例于腹腔镜切除1个肿瘤后采用中转开腹胰岛素瘤摘除并胰体、尾切除.结论 腹腔镜术中超声对胰岛素瘤的检出率及定位诊断准确率高,同时可显示肿瘤的毗邻关系,有助于术中选择合适的手术方式.     

Intraoperative radiation therapy of carcinoma of the pancreas]

From May 1978 to December 1989, 54 patients with pancreatic carcinoma underwent electron beam intraoperative radiotherapy (IORT). Three died of preoperative complications within a month. In 19 patients, liver metastasis and/or peritoneal dissemination became obvious at laparotomy. They therefore underwent IORT with palliative intent. Relief of pain was obtained in 12 of the 14 patients with pain (85.7%), although three of them were treated in combination with splanchnic nerve block. Thirty-two patients with localized carcinoma underwent IORT with curative intent (total tumor resection in 6, partial resection in 6, and no tumor resection in 20). With additional IORT treatment, their survival was significantly (p less than 0.05 during the 18th month) longer than that of 40 patients without IORT (total tumor resection in 13, partial resection in 9, and no tumor resection in 18). Among the patients without tumor resection, the 20 patients who underwent IORT survived significantly (p less than 0.05 during the 7th month) longer than the 18 patients who did not. Twelve patients who underwent total pancreatectomy died earlier than the 23 patients treated with IORT in combination with partial tumor resection or no tumor resection (not significant). In 26 patients with partial tumor resection or no tumor resection, either additional external irradiation or IORT using a small field within a large field significantly (p less than 0.05 during the 7th and 8th month) improved survival compared with IORT using a single field. Of the 20 patients without tumor resection, relief from pain was obtained in 18 of 19 patients with pain (94.7%), although two of them were treated in combination with splanchnic nerve block. In terms of adverse effects possibly caused by IORT in 26 patients who survived longer than 6 months, gastrointestinal problems were serious in several (gastric ulcer in 2, duodenal stenosis in 1, gastric ulcer and duodenal stenosis in 1, and duodenal perforation and duodenal ulcer in 1). In conclusion, our experience suggests that IORT can relieve patients of serious pain and improve survival in patients with localized pancreatic carcinoma.     

脊髓血管母细胞瘤的影像学诊断及治疗

目的探讨脊髓血管母细胞瘤的诊断与治疗方法。方法分析22例脊髓血管母细胞瘤的MRI、DSA的影像学特点,总结栓塞、手术的操作技巧和治疗结果。结果脊髓血管母细胞瘤MRI表现为边界清楚的实性占位、增强后明显均匀强化。DSA表现为边界清楚,圆形或椭圆形高密度影,有明确供血动脉及引流静脉。本组病例直接手术6例,栓塞后手术16例。肿瘤均经手术全部切除,术后功能完全恢复正常12例,加重3例,7例无明显变化。结论MRI和DSA对脊髓血管母细胞瘤的诊断具有特异性,手术治疗是治疗脊髓血管网织细胞瘤的首选方法,栓塞可以降低血管母细胞瘤的血液供应,提高治愈率。     

脊髓空洞症的诊断与显微手术治疗

探讨显微外科技术对脊髓空洞症的治疗效果。127例脊髓空洞症经CT或MRI扫描检查确诊后应用显微外科技术，采取枕-颈减压、空洞切开术或空洞-蛛网膜下腔分流术治疗，并进行平均1.5年以上的随访以评判治疗效果。结果表明，84例经空洞-蛛网膜下腔分流术或空洞切开术的治疗，空洞腔均闭合；43例行枕-颈减压的Arnold-Chiari畸形或脊髓闭合不全者，空洞腔亦见明显缩小，但未全闭合。提示对脊髓空洞症宜采取显微外科手术治疗，可根据病情特点选择枕-颈减压、空洞切开术或空洞-蛛网膜下腔分流的外科术式。     

Global improvement in intellectual and neuropsychological functioning after removal of a suprasellar cystic craniopharyngioma

This is a case report of a patient who presented with cognitive and behavioral decline and underwent surgery for removal of a suprasellar craniopharyngioma. Previous studies have reported memory impairments in the presence of craniopharyngioma, but information is lacking regarding the impact of craniopharyngioma on other brain functions as well as on intellectual abilities. In this study, comprehensive neuropsychological testing, including intellectual testing, was conducted 9 to 14 days before surgery and 16 to 22 days after surgery. Results before surgery demonstrated average intellectual abilities, which were decreased from premorbid estimates, and diffuse neuropsychological impairments. Postoperatively, significant improvement in both intellectual abilities and neuropsychological test scores was observed. These results suggest that craniopharyngiomas can be associated with impairments in intellectual abilities and in brain functions aside from memory. The results are contrasted with those of previous reports, and implications for future research are discussed.     

局部麻醉在老年性腹股沟绞窄疝手术中的临床应用(附9例报告)

目的:探讨局部麻醉行小肠部分切除吻合和(或)大网膜部分切除治疗老年性腹股沟绞窄疝的可行性和安全性。方法:回顾性分析成都军区总医院全军普外中心2007-06～2011-06对9例老年患者采用局部麻醉行腹股沟绞窄疝手术的临床资料,其中单纯行小肠部分切除吻合6例,大网膜部分切除2例,同时行小肠部分切除吻合和大网膜部分切除1例。结果:手术全部成功,手术时间85～128 min,平均98 min,术后住院时间7～11 d,平均8.1 d,1例术后出现切口感染,经换药治愈,其余病例无任何并发症发生。结论:局部麻醉行小肠部分切除吻合和(或)大网膜部分切除治疗腹股沟绞窄疝是安全可行的,特别适用于伴有慢性阻塞性肺疾病(COPD)的老年患者。     

脊柱肿瘤术前选择性动脉栓塞术的临床价值

目的探讨脊柱肿瘤术前选择性动脉栓塞术的临床应用价值。方法回顾性分析2017年1月至2018年12月于中国医科大学附属盛京医院骨科行脊柱肿瘤切除手术的42例患者的临床资料,依据肿瘤切除术前是否行动脉栓塞治疗,将患者分为栓塞组(20例)和未栓塞组(22例),再根据手术方式分为椎体切除亚组和椎板切除亚组。栓塞组椎体切除12例、椎板切除8例;未栓塞组椎体切除13例、椎板切除9例。采用独立样本t检验比较各组间术中失血量、红细胞输入量、校准失血量、手术时间和住院时间的差异。结果栓塞组20例患者均成功实施了脊柱肿瘤动脉栓塞术,无严重并发症发生。栓塞组与未栓塞组患者术中失血量、红细胞输入量、校准失血量、手术时间和住院时间,差异均无统计学意义(P>0.05)。栓塞组椎体切除患者,术中失血量、红细胞输入量和校准失血量分别为(1966.7±898.8)ml、(7.42±3.27)U和(91.3±39.2)g/L,未栓塞组椎体切除患者分别为(2838.5±1143.5)ml、(11.04±4.08)U和(133.0±46.4)g/L,差异均有统计学意义(t值分别为-2.107、-2.436、-2.419,P<0.05);而2组手术时间和住院时间差异均无统计学意义(t值分别为-0.780、-0.549,P>0.05)。栓塞组与未栓塞组椎板切除患者的上述各指标差异均无统计学意义(P>0.05)。结论脊柱肿瘤术前选择性动脉栓塞术相对安全。脊柱肿瘤术前动脉栓塞不能减少外科切除手术的失血量,但对外科术式加以区分后,术前栓塞可显著减少接受椎体切除手术患者的失血量,而椎板切除手术的患者无明显受益。     

MR and CT findings of craniopharyngioma during and after radiation therapy

Long-term changes in craniopharyngioma treated with radiation therapy (RT) were investigated by computed tomography (CT) and/ or magnetic resonance (MR) imaging. Eight patients with craniopharyngioma were treated with incomplete resection or conservative surgical intervention followed by postoperative RT. The periods of tumor shrinkage were often long and varied (range: 6-68 months, mean: 29.1 months). Temporary enlargement of the solid component of a tumor usually occurs during RT and does not represent tumor progression. Cystic enlargement also occurs sometimes comparatively early after RT, and enlarged cysts often shrink with no treatment or with conservative treatment. These changes should be differentiated from tumor recurrence, with careful follow-up. After shrinkage, small solid or cystic nodules enhanced with contrast medium often remain. Long-term follow-up is necessary to differentiate uncontrolled tumors from controlled tumors with imaging modalities.