经口咽齿状突显微切除术若干问题讨论

目的：讨论经口咽齿状突切除术的麻醉插管方法、脑脊液漏的防治、手术技巧及颈椎稳定问题的解决。方法：总结经口咽显微镜下齿状突切除的51例患者。结果：1例术后发生脑脊液漏，导致颅内感染，经修补、对症治疗治愈。1例齿状突磨除10天行后路植骨，3天后因喝水呛咳突然呼吸停止，四肢瘫痪，立即经气管切开处插管，呼吸机辅助呼吸，颅骨牵引，20天后恢复。1例呼吸困难、心跳快者术后即恢复正常。出院时所有肌张力高者均有不同程度的降低，肢体麻木明显减轻，12例患者病理征消失。随防12-321个月，平均17．5个月，肌力Ⅳ级23例，Ⅴ级28例，肌萎缩部分恢复，病理征消失。结论：气管切开插管有利于显露。磨钻摆动、硬膜牵拉容易撕裂硬脊膜引起脑脊液漏、损伤脑干，若齿状突后纤维组织增生钙化予以切除。齿状突切除3周后路植骨融合较为安全。

The Problems of Transoropharynx Odontoid Process Excision

Objective： To dicuss the problems of transoropharynx odontoid process excision such as the methods of the anesthesia intubation, prevention and treatment of the cerebrospinal fluid leak, the stability of the cervical spine and operation skills. Methods： 51 patients underwent the transoropharynx odontoid process excision. Results： 1 patient had cerebrospinal fliud leak, resulting in intracranial infeion and cured after repairing and symptomatic treatment. 1 case of the dens removal, 10 days later underwent posterior fusion, 3 days after surgery who got respiratory arrest and tetraplegia as bucking when drinking water, cannulas by incision of tracheaion was perfomed at once,the assisted respiration with the respirator and the skull traction were followed. The patient recoved 20 days later. 1 case of dyspnoea and rapid heart beating recoved postoperatively. All cases of hyper-muscular tension, the muscular tension decreased by different degrees, and the limbs mumbness were decreased obviously. The pathological signs of 12 cases were abolited. Conclusion：The trachea section cannulas is good for exposure,the milling drill oscillation and the dura-mater drag can tearing the dura mater of spinal cord and cause the spinal fluid leak,damage the brain stem. If the posterior fibrous tissue of the dens was proliferation and calcification,it should be removed. The posterior fusion is security when the odontion process excision performed 3 weeks later.