摘要 目的：进一步了解和认识延颈部胶质瘤，提高显微外科手术技巧，减少手术并发症，予病人术后良好生存质量。方法：系统分析了1983～1997年我所主要经显微外科手术治疗的34例延颈部胶质瘤(室管膜瘤组和星形细胞瘤组)的临床及影像学表现，鉴别诊断，显微手术治疗和随访结果。结果：本组室管膜瘤的手术全切率83%；星形细胞瘤组为66%。平均随访时间近3年，室管膜瘤组病人恢复工作及生活自理者占93%，星形细胞瘤组占53%。结论：MRI检查对该区域肿瘤的定性诊断及手术设计有帮助。积极手术治疗及微创的显微外科技巧是保证减少术后并发症，获得较好预后的关键。完全生长在髓内涉及闩部的肿瘤，手术风险大。术后要积极防治Ⅸ、Ⅹ颅神经及呼吸障碍等严重并发症，以保病人顺利度过术后期。对大多数病人，建议术后辅以放疗。

Abstract Objective:To understand the gliomas of medullocervical junction deeply, improve the operative skill, reduce operative complications, and return a satisfactory living quality to the patients. Methods: During 1983-1997 thirty-four patients with the gliomas of medullocervical junction, divided into ependymoma group (Ⅰ) and astrocytoma group (Ⅱ) were treated in our institute. Their clinical manifestations and neuro-images, differential diagnosis, results of microsurgery and follow-up were analyzed. Results: In group Ⅰ, total removal of tumors was achieved in 83%, and group Ⅱ in 66%. The follow-up was range from 6 to 183 months (mean 3 years). 93% patients have resumed their work and/or living independently in group Ⅰ, compared with 53% in group Ⅱ. Conclusions: MR examination is decisive in the differential diagnosis and operative design. An aggressive surgical treatment and minimally invasive technique are crucial for reducing the operative complications and achieving good results. It is risky to manipulate those intrinsic tumors involving the obex. Managing disturbances of the respiration and Ⅸ,Ⅹ cranial nerves properly are quite important during the postoperative period. Radiotherapy is considered as a supplementary therapy for most patients.

     Key words Medullocervical junction Gliomas Microsurgery

延颈部胶质瘤的病变部位和性质决定了其临床表现的复杂性及手术治疗的风险性 ......