听神经瘤术后复发再手术

目的 探讨听神经瘤术后复发的相关因素及处理方法。方法 收集本科105例听神经瘤手术的临床资料，随访资料完整的64例，进行回顾性研究。结果 105例听神经瘤手术病例，全切79例（75．2％），部分切除12例（11．4％），留有残片14例（13．3％）：随访资料完整的64例，其中复发8例：复发率12．5％（8／64）；复发病例都为早期手术病例（1998年以前）；肿瘤越大，复发率越高；复发率最高的年龄段在40~59岁：全切后复发1例，部分切除或囊内切除术后复发6例，留有残片后复发1例；其中迷路入路复发率为21．1％（4／19），乙状窦后入路10．5％（4／38），中颅窝入路为0％；复发时间为术后10个月～9年。复发病例全部进行再次手术；再次手术采用乙状窦后入路，全部切除肿瘤；除面瘫外，无严重并发症出现。结论 听神经瘤术后复发者大部分为术中未完全切除病例，听神经瘤的早期诊断、早期手术、全部切除是减少复发率的主要因素。复发病例需要再手术，对有高风险复发的病例如肿瘤较大、部分切除、高发病的年龄要定期随访，至少随访3年以上。

Recurrence of acoustic neuroma and management after surgery

OBJECTIVE To investigate the correla- tion factor of recurrence of acoustic neuroma and man- agement after surgery. METHODS To analyse retro- spectively 105 cases of acoustic neuroma. RESULTS Of 105 patients, 79 were totally resected and 12 were partially resected. There were relics on brain stem and nervous tissue in 14 cases. There are 64 cases have follow up information completely. The recurrence rate is 12.5 % (8/64),and all of the recurrent cases were at the early stage of this operation;The recurrence rate is proportional to tumor size. The peak age of recurrence is at the period of 40-59 years old. There was 1 case recurred in the total resection group; 6 cases in partial resection;1 cases in relic on brain stem and nervous tissue. And the recurrence rate in labyrinth approach , retrosigmoid approach and middle cranial fossa ap- proach was 21.1 %(4/19), 10.5 % (4/38)and 0 % respectively. The onset of recurrence at the period 10M- 9Y after surgery. And all the recurrent cases under- went re-operation and without serious complications. CONCLUSION The majority of the recurrent cases of acoustic neuroma were those without complete removal of the tumor. And the key point of reducing recurrence is early diagnosis, early operation. The cecurrent cases need re-operation. And the follow-up should be at least 3 years.