协和医学杂志

2012, (02)

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颈静脉孔区肿瘤临床分析
Clinical analysis of Jugular foramen tumors

陈晓巍;冯国栋;高志强;姜鸿;李五一;亓放;田旭

摘要(Abstract):

[摘要] 目的:对12例颈静脉孔区肿瘤患者的诊断和治疗进行回顾性分析,探讨该区域肿瘤的诊断特点及手术要点。方法:对2008年2月—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研究。全部患者均行CT或MRI检查。12 例均采用显微外科手术切除,随诊14-45月。结果:12例颈静脉孔区肿瘤术后病理证实 :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。其中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。其中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例术后症状改善5例,症状无改善5例,症状加重2例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+1型甲状成形术,另1例于术后7个月行食管上括约肌切除+1型甲状成形术,术后病情明显改善。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血管神经功能是手术治疗的要点。
Abstract Objective By retrospectively analyzed the clinical manifestations and the treatment of twelve patients with jugular foramen tumors to evaluate the diagnosis characteristics and the key surgical point for treatment of this region tumors.Methods Retrospective study on twelve patients with jugular foramen tumors treated surgically from February2008 to December 2010.All patients underwent CT or MRI,twelve cases all using microsurgical techniques removing the tumor and were followed up for 14-45 months.Results Twelve cases of jugular foramen tumors confirmed by post-operation pathology: eight were paraganglioma, one hypoglossal nerve sheath tumors, one meningioma, one chondrosteoma, one middle ear cholesterol granuloma. Eleven cases complete surgical resection of the tumor, one case near-total resection of the tumor and postoperative treated by gamma knife. Four cases carried out one-stage facial nerve reconstruction, including two cases of auricular nerve grafting, two cases of facial - hypoglossal nerve anastomosis. Postoperative five cases symptoms improved, five cases no improvement in symptoms, two cases symptoms worsened mainly for severe dysphagia and hoarseness ie Ⅻ,Ⅹ cranial nerve permanent palsy, one did the Cricopharyngeal cut and typeⅠthyroplasty five months post-operation,and the other did esophageal sphincter resection and typeⅠthyroplasty in seven months post-operation, both significantly improved the postoperative condition. Conclusion The anatomy environ the region of jugular foramen tumors is multiplicity, we should choose the appropriate surgical approach based on the patient's different situations and images 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.

关键词(KeyWords): |颈静脉孔|颅底肿瘤|耳显微外科手术 颅神经功能重建|
|Jugular foramen |Skull base tumor| Otologic micorsurgical operation| Cranial nerve function reconstruction|

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作者(Author): 陈晓巍;冯国栋;高志强;姜鸿;李五一;亓放;田旭

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