颈静脉孔区肿瘤的手术治疗

目的探讨颈静脉孔区肿瘤的手术治疗要点。方法对北京协和医院2008年2月至2010年12月临床资料完整的12例颈静脉孔区肿瘤患者进行回顾性分析。所有患者均行CT或MRI检查,均采用显微外科手术切除肿瘤,术后随诊14～45个月。结果 12例颈静脉孔区肿瘤患者中,11例手术完整切除肿瘤,1例肿瘤近全切除,术后行伽马刀治疗。4例进行了同期面神经重建术,包括2例耳大神经移植术,2例面—舌下神经吻合术。12例患者术后病理结果 ：8例副神经节瘤,1例舌下神经鞘膜瘤,1例脑膜瘤,1例软骨骨瘤,1例中耳胆固醇肉芽肿。5例患者术后症状改善,5例症状无改善,2例症状加重,主要表现为严重的吞咽困难、声音嘶哑,即第Ⅻ、Ⅹ颅神经麻痹,其中1例于术后5个月行环咽肌切断并Ⅰ型甲状成形术,另1例于术后7个月行食管上括约肌切除并Ⅰ型甲状成形术,术后病情均明显改善。结论颈静脉孔区肿瘤周围解剖复杂,应根据患者的不同情况及影像学资料选用适宜的手术入路进行个体化治疗,彻底切除肿瘤并保留或重建重要的血管神经功能是手术治疗的要点。

Surgical Treatment of Jugular Foramen Tumors

Objective To evaluate the key surgical points for treatment of jugular foramen tumors.Methods Twelve patients with jugular foramen tumors treated surgically from February 2008 to December 2010 in Peking Union Medical College Hospital were reviewed retrospectively.All patients underwent CT or MRI.Their tumors were removed using microsurgical techniques and they were followed up for 14-45 months.Results Among 12 patients with jugular foramen tumors,11 underwent complete surgical resection of the tumor,1 underwent near-total resection of the tumor and postoperatively treated by gamma knife.One-stage facial nerve reconstruction was carried out in 4 cases,including 2 cases of auricular nerve grafting and 2 cases of facial-hypoglossal nerve anastomosis.The pathological results of 12 cases showed that 8 were paraganglioma,1 hypoglossal nerve sheath tumor,1 meningioma,1 chondrosteoma,and 1 middle ear cholesterol granuloma.Five cases achieved improved symptoms postoperatively,5 cases had no improvement in symptoms,and 2 cases had worsened symptoms with severe dysphagia and hoarseness,mainly for Ⅻ,Ⅹ cranial nerve permanent palsy.One of the cases with worsened symptoms underwent cricopharyngeal myotomy and typeⅠthyroplasty 5 months after operation,and the other underwent esophageal sphincter resection and typeⅠthyroplasty 7 months after operation.Both achieved significantly improved postoperative condition.Conclusions The anatomical environment of the region of jugular foramen tumors is complex,and we should choose the appropriate surgical approach based on patients’ different situations and image data for individualized treatment.To completely remove the tumor and retain or reconstruct the major blood vessels and nerve function is the key point for surgical management.