听神经瘤的再手术(附11例分析)

为进一步提高听神经瘤手术的临床疗效，对１５８例听神经瘤手术后１１例再次手术患者进行临床分析，发现肿瘤大小、切除方式以及手术进路与临床症状复发密切相关。肿瘤越大，复发机会越多；大部切除，次全切除及全切除的复发再手术率分别是１９．４％、１３．２％和０；迷路后进路手术复发再手术率最高，达３３．３％。防止临床复发最根本的措施是术中尽量减少肿瘤残留，力争全切。为达此目的要求早期诊断，选择适当的手术进路。对不能全切的较大肿瘤，次全切除能有效地延缓临床复发时间，减少并发症。计算了术前以及术后肿瘤的增长速度以及肿瘤倍增时间及再手术间期，建议术后每半年进行一次影像检查，对于早期发现复发有重要意义。Ｘ刀是对付早期肿瘤复发的有效办法。再手术中的并发症除损伤面神经外，其它少见。

Recurrent acoustic neuroma: report of 11 cases

To improve the therapeutic effect of acoustic neuroma,158 patients with acoustic neuroma treated in our hospital were retrospectively reviewed.Among them,11 recurrent acoustic neuroma were found.The clinical analysis demonstrated that the recurrence of acoustic neuroma had close relationship with the size of the tumor,operative approach and extent of excision.All recurrent acoustic neuroma was large sized when first operated.The more the tumor was excised,the lower the recurrent rate was.The recurrent rates were 19.4% for partial resection,13.2% for near total resection,0% for total resection respectively.Retrolabyrinthine approach was more likely to recur than other approaches.The key to decrease recurrent rate was to excise as much tumor as possible.According to growth rate and double time of acoustic neuroma measured in this study,regular follow up with CT or MRI at interval of 6 months was emphasized.X knife was effective for early diagnosed recurrent acoustic neuroma.