摘要
目的 探讨颈静脉孔区肿瘤行显微外科手术治疗的情况及其预后. 方法 自1999年1月至2013年12月,对54例颈静脉孔区肿瘤的患者均经Fisch入路行显微手术治疗.术中行肿瘤全切除或近全切除38例,肿瘤大部分切除16例,其中,术后加放疗或γ刀治疗7例.术中全部病例均行面神经监测,行面神经解剖及改道移位35例,面神经“桥梁化”9例,面神经部分切除10例,其中,同期行面神经-舌下神经吻合4例,面神经-耳大神经移植3例. 结果 术中41例行外耳道封闭,35例行临近带蒂颞肌瓣术腔填塞,6例行术腔脂肪填塞;术后18例出现不同程度面瘫,其中,14例于术后2周至9个月内不同程度改善,4例未改善;1例术前出现同侧喉返神经麻痹,术后半年好转.术后2例出现皮下血肿,1例出现伤口感染不愈合,经清创缝合及加强抗感染治疗后均好转;2例出现术腔填塞物坏死,经清创换药后好转.随访6个月-5年,除9例有部分肿瘤残留或复发外,其余未见明显复发. 结论 Fisch入路对颈静脉孔区肿瘤行手术治疗具有暴露好、视野清晰、方便止血的优点,术中行面神经监测,必要时可在术中行面神经解剖、“桥梁化”或改道移位,更有利于肿瘤完全或近完全切除,减少神经损伤.术后行术腔填塞及选择性外耳道封闭可有效地减少术腔积液及术后感染的发生率.
Objective To summarize the condition of surgical treatment and prognosis of 54 cases of jugular foramen tumors in the past 5 years.Methods All 54 cases were treated with operation by Fisch approach.Thirty-eight cases underwent total or near total resection of the tumor.Most resection of the tumor was underwent in 16 cases,in which,7 cases underwent postoperative radiotherapy or gamma knife therapy.The facial nerve monitoring was used in all cases.The facial nerve was anatomized and shifted in 35 cases,was just anatomized like a ＂bridge＂ in 10 cases,and was excised partly in 9 cases,in which,4 cases underwent facial-hypoglossal nerve anastomosis and 3 cases underwent transplantation of facial nerve and great auricular nerve.Results The external auditory canal was closed in 41 cases.The near pedicled temporalis muscle flap was obliterated in the operating cavity in 35 cases.Six cases underwent fat filling in the operating cavity.Eighteen patients showed facial palsy in varying degrees after operation.Among them,14 cases improved to different extents in 2 weeks to 9 months and 4 cases did not improve.One case showed recurrent laryngeal nerve paralysis in the same side before operation and improved in half a year after operation.Postoperative subcutaneous hematoma occurred in 2 cases,wound infection in 1 case.All the cases improved by debridement suture and anti-infective therapy.The cavity filling necrosis occurred in 2 cases,which recovered after debridement and dressing.For half a year after operation,except 9 cases of residual or recurrent,and the rest showed no recurrence.Conclusion The Fisch approach of surgical treatment of jugular foramen tumors can provid good exposure,clear vision,facilitate hemostasis.The skills of intraoperative facial nerve monitoring,facial nerve anatomy like a ＂bridge＂ or anatomy and shift when necessary are beneficial to the total or nearly total resection of tumor and reduce the injury of facial nerve.The operating cavity filling and selective external auditory canal closure can effectively reduce the surgical cavity effusion and the incidence of postoperative infection.
出处
《中华显微外科杂志》
CSCD
北大核心
2015年第4期334-337,共4页
Chinese Journal of Microsurgery
基金
广东省科技计划社会发展项目（20098060700046）
