神经内镜手术治疗颅底肿瘤的应用研究(1)
摘要:目的 分析神经内镜手术治疗颅底肿瘤的方式,探究其临床应用价值。方法 选择我院门诊在2014年5月~2016年5月期间所收治的60例颅底肿瘤患者作为研究对象,将其随机分为对照组和观察组各30例。对照组采取单纯显微镜手术方式,观察組采取神经内镜手术方式,对两组患者的肿瘤切除率、并发症发生率和术后随访情况等进行对比分析。结果 观察组中有肿瘤全切除28例,次切除2例,并发症发生率为13.33%(4/30);而对照组中有全切除21例,次切除7例和大部分切除2例,术后并发症发生率为36.67%(11/30),差异具有统计学意义(P<0.05)。结论 神经内镜手术治疗颅底肿瘤,不仅能够提高手术的安全性,提高肿瘤切除率,而且还有效的缩短了手术时间,降低并发症的发生率,在临床中具有较高的推广应用价值。
关键词:神经内镜手术;颅底肿瘤;治疗应用
Application of Neuroendoscopic Surgery in the Treatment of Skull Base Tumors
, http://www.100md.com
LU Ping
(Department of Neurosurgery,General Hospital of Offshore Oil,Tianjin 300452,China)
Abstract:Objective To analyze the method of endoscopic sinus surgery for skull base tumors and explore its clinical value.Methods 60 patients with skull base tumors were selected from May 2014 to May 2016 in our hospital.The patients were randomly divided into control group and observation group(30 cases).The control group was treated with simple microscope.The observation group was treated by neuroendoscopic surgery.The tumor resection rate,complication rate and postoperative follow-up were compared between the two groups.Results In the observation group,there were 28 cases of total resection and 2 cases of subtotal resection.The complication rate was 13.33%(4/30).In the control group,there were 21 cases of total resection,7 cases of resection and 2 cases of resection,the incidence of postoperative complications was 36.67%(11/30),the difference was statistically significant(P<0.05).Conclusion Neuroendoscopic surgery for skull base tumors can improve the safety of the operation and improve the tumor resection rate,but also shorten the operation time and reduce the incidence of complications.It has high application value in clinical practice.
, 百拇医药
Key words:Neuroendoscopic surgery;Skull base tumors;Therapeutic applications
颅底肿瘤指的是发生在颅底及其相邻结构,可由颅内向颅外,或由颅外向颅内发展的一种肿瘤病症,在医学临床中较为常见的有垂体瘤、颅咽管瘤、鞍结节脑膜瘤以及海绵窦肿瘤等[1]。患有颅底肿瘤的患者主要表现为颅内压增高、视觉和嗅觉等功能减退、面部麻木或疼痛以及四肢无力等症状,对于患者的身体健康和生命安全构成了严重的威胁。目前,手术治疗是颅底肿瘤的主要方式,而神经内镜作为一种有效的辅助手段,在临床中也实现了较为广泛的应用。为了探究神经内镜手术治疗颅底肿瘤的效果,特选取60例患者进行了研究,现将具体的研究报告总结如下:
1 资料与方法
1.1一般资料 选择我院门诊在2014年5月~2016年5月期间所收治的60例颅底肿瘤患者作为研究对象,其中男29例,女31例,年龄16~70岁,肿瘤直径2.5~7.0 cm,病程4个月~5年;按照肿瘤分型进行划分:脑膜瘤22例,垂体瘤15例,胆脂瘤11例,神经鞘瘤8例,颅咽管瘤3例和1例脊索瘤。所有患者均表现出不同程度的头痛、视力减退、耳鸣和肢体无力等症状,排除了有糖尿病史、肾脏等重要器官疾病、颅内其他病变和肿瘤手术史的患者;将其随机分为对照组和观察组各30例。在术前经MRI增强扫描检查和病理检查确诊为颅底肿瘤,且两组患者在性别、年龄、病程等一般资料的对比差异上无统计学意义(P>0.05),具有可比性。
1.2方法 对照组采取显微镜手术方式,观察组采取神经内镜手术方式,选用由德国Storz型内窥镜手术系统,其直径为40 mm,长为182 cm的0°和70°广角内镜;指导患者呈仰卧位,头抬高30°,采取经口气管插管的全身麻醉方式,根据肿瘤的实际部位、大小、生长方式以及附着点等情况分别选择与之相适应的入路方式。其中,在额下入路中,对鞍结节脑膜瘤、巨大胆脂瘤和嗅沟脑膜瘤行硬膜内入路,对侵及眶内和副鼻窦前颅底脑膜瘤行硬膜外入路;垂体腺瘤、蝶骨嵴脑膜瘤和颅咽管瘤行改良翼点入路;桥小脑角脑膜瘤行颞下经小脑幕入路,岩斜区胆脂瘤在内镜下经岩骨乙状窦前入路;同时根据肿瘤和周围结构的相粘连、侵蚀等情况,对其切除范围予以确定;在切除部分肿瘤之后,将内镜置于瘤腔,对瘤腔结构予以观察,并切除残余肿瘤[2]。, 百拇医药(路平)
关键词:神经内镜手术;颅底肿瘤;治疗应用
Application of Neuroendoscopic Surgery in the Treatment of Skull Base Tumors
, http://www.100md.com
LU Ping
(Department of Neurosurgery,General Hospital of Offshore Oil,Tianjin 300452,China)
Abstract:Objective To analyze the method of endoscopic sinus surgery for skull base tumors and explore its clinical value.Methods 60 patients with skull base tumors were selected from May 2014 to May 2016 in our hospital.The patients were randomly divided into control group and observation group(30 cases).The control group was treated with simple microscope.The observation group was treated by neuroendoscopic surgery.The tumor resection rate,complication rate and postoperative follow-up were compared between the two groups.Results In the observation group,there were 28 cases of total resection and 2 cases of subtotal resection.The complication rate was 13.33%(4/30).In the control group,there were 21 cases of total resection,7 cases of resection and 2 cases of resection,the incidence of postoperative complications was 36.67%(11/30),the difference was statistically significant(P<0.05).Conclusion Neuroendoscopic surgery for skull base tumors can improve the safety of the operation and improve the tumor resection rate,but also shorten the operation time and reduce the incidence of complications.It has high application value in clinical practice.
, 百拇医药
Key words:Neuroendoscopic surgery;Skull base tumors;Therapeutic applications
颅底肿瘤指的是发生在颅底及其相邻结构,可由颅内向颅外,或由颅外向颅内发展的一种肿瘤病症,在医学临床中较为常见的有垂体瘤、颅咽管瘤、鞍结节脑膜瘤以及海绵窦肿瘤等[1]。患有颅底肿瘤的患者主要表现为颅内压增高、视觉和嗅觉等功能减退、面部麻木或疼痛以及四肢无力等症状,对于患者的身体健康和生命安全构成了严重的威胁。目前,手术治疗是颅底肿瘤的主要方式,而神经内镜作为一种有效的辅助手段,在临床中也实现了较为广泛的应用。为了探究神经内镜手术治疗颅底肿瘤的效果,特选取60例患者进行了研究,现将具体的研究报告总结如下:
1 资料与方法
1.1一般资料 选择我院门诊在2014年5月~2016年5月期间所收治的60例颅底肿瘤患者作为研究对象,其中男29例,女31例,年龄16~70岁,肿瘤直径2.5~7.0 cm,病程4个月~5年;按照肿瘤分型进行划分:脑膜瘤22例,垂体瘤15例,胆脂瘤11例,神经鞘瘤8例,颅咽管瘤3例和1例脊索瘤。所有患者均表现出不同程度的头痛、视力减退、耳鸣和肢体无力等症状,排除了有糖尿病史、肾脏等重要器官疾病、颅内其他病变和肿瘤手术史的患者;将其随机分为对照组和观察组各30例。在术前经MRI增强扫描检查和病理检查确诊为颅底肿瘤,且两组患者在性别、年龄、病程等一般资料的对比差异上无统计学意义(P>0.05),具有可比性。
1.2方法 对照组采取显微镜手术方式,观察组采取神经内镜手术方式,选用由德国Storz型内窥镜手术系统,其直径为40 mm,长为182 cm的0°和70°广角内镜;指导患者呈仰卧位,头抬高30°,采取经口气管插管的全身麻醉方式,根据肿瘤的实际部位、大小、生长方式以及附着点等情况分别选择与之相适应的入路方式。其中,在额下入路中,对鞍结节脑膜瘤、巨大胆脂瘤和嗅沟脑膜瘤行硬膜内入路,对侵及眶内和副鼻窦前颅底脑膜瘤行硬膜外入路;垂体腺瘤、蝶骨嵴脑膜瘤和颅咽管瘤行改良翼点入路;桥小脑角脑膜瘤行颞下经小脑幕入路,岩斜区胆脂瘤在内镜下经岩骨乙状窦前入路;同时根据肿瘤和周围结构的相粘连、侵蚀等情况,对其切除范围予以确定;在切除部分肿瘤之后,将内镜置于瘤腔,对瘤腔结构予以观察,并切除残余肿瘤[2]。, 百拇医药(路平)