巨型颈静脉球瘤术后并发症的护理

报告了1例巨型颈静脉球瘤患者术后并发症的护理对策.术前对护理人员进行疾病专科知识培训,对患者进行有效的评估,提出术后预见性护理;术后针对患者发生脑水肿、面瘫、吞咽困难、压疮并发症,实施有效的护理措施,保证了手术疗效.     

鼓室体瘤的诊治

鼓室体瘤是局限于鼓室内的起源于鼓室的舌咽神经鼓室支及迷走神经耳支的化学感受器瘤,起源于副神经节,也称为鼓室副神经节瘤,早期主要在鼓室内生长[1]。因其病变原发于中耳腔及鼓室而得名。而病变原发于颈静脉体者则称为颈静脉体瘤。两者均起源于副神经节,故又称副神经节瘤。此瘤在组织结构上属化学感受器瘤。该病临床上的典型表现为波动性耳鸣、耳闷感;有轻度传导性聋;局部检查,透过鼓膜可见鼓岬表面红色肿块,中耳CT显示鼓岬处有边缘光滑的软组织占位改变,乳突无破坏。实际工作中我们发现该病临床上比较少见,并且表现多样,不典型,容易误诊误治,现报道我院3例鼓室体瘤病例临床资料。     

颈静脉孔区肿瘤临床表现及影像学分析

目的探讨颈静脉孔区肿瘤的临床特点、影像学特征。方法回顾性分析2006年5月-2009年12月32例颈静脉孔区肿瘤的临床及影像学资料,术前32例患者均行颞骨薄层CT和头颅MRI平扫加增强扫描,22例怀疑颈静脉球瘤患者于术前24dx时内行血管造影和肿瘤供血血管栓塞。32例颈静脉孔区肿瘤有31例行肿瘤全切手术,1例怀疑颈静脉球瘤患者因乙状窦血栓性静脉炎导致患者反复发热未行手术治疗。术后病理诊断颈静脉球瘤21例,神经鞘瘤10例。结果32例颈静脉孔区肿瘤主要临床表现为耳鸣、听力下降和周围性面神经麻痹。颈静脉球瘤的特征性表现为侵蚀性骨质破坏及“盐和胡椒”征：神经鞘瘤表现为压迫性骨质改变、多发囊变并中度强化。结论CT与MRI的合理结合应用,有助于病变的临床诊断和鉴别,有利于下一步手术方案的选择。     

颈静脉球瘤切除并跨面神经移植患者的护理

报告了1例颈静脉球瘤切除并跨面神经移植患者的护理。术前重点做好血管的评估、皮肤准备,完善各项术前检查;术后做好生命体征及病情的严密观察、切口及引流的观察、并发症的观察与护理,做好口腔护理及面瘫的康复护理,这是保证手术成功的关键。     

Surgical Resection of Jugulare Foramen Tumors by Juxtacondylar Approach Without Facial Nerve Transposition

Summary  Presentation. Jugulare foramen tumors (JFT) remain a difficult challenge especially in the forms extending extradurally and invading the petrous bone. In the standard technique, facial nerve function is placed at risks because of its transposition. We report on 31 extradural (N=11) or intra-extra dural (N=20) JFT resected surgically using the juxtacondylar approach alone or in combination with the infratemporal approach and without facial nerve transposition.  Results. The juxtacondylar approach permits the opening of the JF on its posteroinferior aspect and thus reduces the extent of petrous bone drilling. In tumors strictly located in the JF (N=11), no petrous bone drilling is necessary and the facial nerve is never exposed. In tumors extending into the petrous bone (N=20), the facial nerve was never transposed and moreover was kept in its bony canal in 15 cases. In only 5 cases, was the fallopian canal opened as the tumor was invading its bony wall. Similarly hearing function, when pre-operatively intact was always preserved and a better preservation of the lower cranial nerves could be achieved. Whatever the tumoral extent along the petrosal carotid artery, a radical resection could be realized in 30 cases.  Conclusion. Therefore, we consider the juxtacondylar approach a useful adjunct to increase the possibilities of resection of JFT; it allows a better preservation of the neurovascular structures, especially the facial nerve which is kept in place and moreover kept in its bony canal when it is not invaded by the tumor.