幕上脑出血外科治疗方法选择探讨

回顾性总结我院2006年至2011年间手术治疗的幕上脑出血122例,现将治疗方法的选择分析报告如下。     

83例颅内室管膜肿瘤临床分析

目的 总结颅内室管膜肿瘤的临床特点,探讨其预后相关因素.方法 回顾性总结83例颅内室管膜肿瘤的分布、年龄、病理及影像学特点,分析其手术治疗及辅助治疗的效果.结果 83例颅内室管膜肿瘤中幕下室管膜肿瘤41例,幕上室管膜肿瘤42例.年龄≤15岁37例,＞15岁46例.病理按WHO肿瘤组织学分级:Ⅰ～Ⅱ级58例(69.9%),Ⅲ级25例(30.1%).手术全切67例(80.7%),次全切16例(19.3%).5年存活率81.9%(68/83).手术切除程度和病理分级是影响颅内室管膜肿瘤患者预后的高危因素.结论 肿瘤全切可明显改善患者的预后.术后发现肿瘤残留,适.合者可考虑二次手术切除.间变性室管膜瘤预后较差.放疗在颅内室管膜肿瘤的治疗中具有重要作用,化疗作用有限,主要尝试用于婴幼儿以避免放疗的副损害.

Abstract：

Objective To study the clinical features of patients with intracranial ependymal tumour, and explore the prognostic factors which have.a significant association with the outcome. Methods Eighty-three patients with histologically proven ependymal tumour were retrospectively reviewed. The tumour location, the patients' age, the histological features, imaging characteristics, surgical management and adjuvant therapy were studied. Results In 83 cases of intracranial ependymal tumour,41 cases were infratentorial and 42 cases were supratentorial ependymal tumour, 37 patients age ≤15 years, while 46patients age ＞ 15 years. Fifty-eight patients ( 69.9% ) and 25 patients (30.1% ) had low (WHO Ⅰ - Ⅱ ) and high-grade (WHOⅢ) tumors respectively. Sixty-reven (80.7%) patients had gross total resection and 16patients ( 19.3% ) had subtotal resection. The 5-year survival rate was 81.9%( 68/83 ). The factors that were found to have a statistical significance association with the outcome were the extent of the resection and the pathologic characteristics. Conclusions Gross total resection of these tumors results in a good long-term outcome. Reoperation should be considered, if feasible, to remove residual malignant tissue. Anaplastic ependymomas carries a much poorer prognosis. Radiotherapy may play an important role in their treatment.The role of chemotherapy appears limited but can be attempted, especially in the very young, in order to avoid the deleterious effect of radiotherapy.     

室管膜肿瘤的临床研究进展

室管膜肿瘤是相对少见的胶质瘤,颅内室管膜肿瘤多发生于儿童和青少年,脊髓室管膜肿瘤则多见于成年人。虽然室管膜肿瘤病理特征趋向良性,但因其有复发倾向而使治疗棘手,临床上有关室管膜肿瘤的合理治疗一直存有争议。就此结合文献总结颅内和脊髓室管膜肿瘤的临床特点,分析当前的治疗方法及进展,探讨其预后相关因素,为临床治疗提供参考。     

显微手术治疗脑胶质瘤的临床分析

①目的探讨显微手术切除脑胶质瘤的疗效及其技巧。②方法回顾性分析显微手术切除及术后病理确诊的胶质瘤22例患的临床资料。③结果手术全切14例，次全切6例，大部分切除2例。术后运动及语言等神经功能未受影响，无手术并发症。④结论脑胶质瘤采用显微手术效果好，是手术治疗的首选。尤其对于位于重要功能区的肿瘤，只要严格按肿瘤边界切除肿瘤，即可减少功能障碍的发生，提高术后生存质量。     

巨大硬膜外血肿行血肿清除去骨瓣减压术的临床分析

急性硬膜外血肿 (Extradural hematoma,EDH)手术多为骨瓣开颅 ,清除血肿后不需去骨瓣减压。但对于血肿巨大及压迫时间较长的 EDH,因术后可产生较重脑水肿而致颅内压增高病情恶化 ,为增加病人的获救机会而行血肿清除去骨瓣减压。就此本文分析了我院1994年至 2 0 0 0年间行血肿清除去骨瓣减压术的急性幕上 EDH2 1例 ,现报告如下。1　临床资料1.1　一般资料 :男 16例 ,女 5例。年龄 18岁～ 6 1岁 ,平均年龄 39.6 2岁。受伤原因 :交通事故 15例 ,打击伤3例 ,坠落伤 1例 ,其它 2例。1.2　入院时情况 :伤后均有原发昏迷 ,无中间清醒期。GCS…     

两种手术方法治疗高血压脑出血疗效分析

开颅血肿清除术和定向血肿穿刺抽(碎)吸术是治疗高血压脑出血(HICH)的两种重要方法,对这两种方法的疗效目前看法不尽一致,疗效比较的报道尚不多。笔者选择自1994年以来我院收治的42例行开颅血肿清除去骨瓣减压术,和40例行定向血肿穿刺抽(碎)吸术的病人进行比较,报告如下。