학술논문
后颅窝复杂血管网织细胞瘤的显微外科治疗策略及疗效分析 / Complex of hemangioblastoma in posterior cranial fossa microsurgical treatment and clinical analysis
Document Type
Academic Journal
Author
李欢; 郭腾显; 王亮; 郝淑煜; 李达; 张力伟; 张俊廷; 吴震; LI Huan; GUO Teng-xian; WANG Liang; HAO Shu-yu; LI Da; ZHANG Li-wei; ZHANG Jun-ting; WU Zhen
Source
中国医刊 / Chinese Journal of Medicine. 52(8):59-63
Subject
Language
Chinese
ISSN
1008-1070
Abstract
目的 探讨后颅窝复杂血管网织细胞瘤的显微外科治疗策略及治疗效果.方法 回顾性分析2006年6月至2016年6月在本院神经外科行手术治疗的227例后颅窝复杂血管网织细胞瘤患者的临床资料,总结手术技巧,分析术后并发症,在不同时间点评估患者的Karnofsky(KPS)评分,以Wilcoxon符号秩检验比较最后一次随访与术前KPS评分之间的差异.结果 单发病灶88例,多发病灶139例,合并有Von Hippel-Lindau(VHL)综合征32例,肿瘤平均直径为(3.23±1.62)cm,最多见部位为延髓(97例,42.7%),最常见的首发症状为头痛头晕(84例,37%).132例患者术前接受脑血管造影检查,其中53例行供血动脉选择性栓塞.病灶全切除224例(98.7%),近全切除3例(1.3%).术后最常见的并发症为肺并发症(56例,其中3例患者死亡).术后行气管切开术27例,行脑室腹腔分流术18例.患者入院时术前KPS评分为(84.21±8.67)分,最后一次随访时KPS评分为(92.73±10.19)分,两者比较差异有显著性(P=0.027).结论 手术切除是治疗复杂血管网织细胞瘤的主要手段,采用术前选择性部分栓塞供血动脉及术中精细的显微外科操作策略可获得较好的治疗效果.术后肺部并发症为影响患者预后的重要因素,应高度警惕并及早干预.
Objective To explore the microsurgical strategy of complicated hemangioblastoma and evaluate the outcome. Method A retrospective analysis of the clinical data and surgical results was performed in 227 complicated hemangioblastoma at posterior cranial fossa. Result There were 88 solitary and 139 multiple lesions. 32 cases were associated with VHL. The mean diameter of the lesion was (3.23±1.62)cm. The most common location was medulla oblongata and the most common symptom onset was headache and dizziness (37.1%). 132 patients underwent DSA and the embolization of feeding artery was performed in 53 patients. The gross total resection was achieved in 224 patients and subtotal resection in 3 patients. 18 patients underwent the V-P shunt and 27 patients underwent tracheotomy. The pulmonary complications was the most serious complications leading to 3 death. The preoperative KPS was 84.21±8.67 while the last follow-up KPS was 92.73±10.19, which was different in significant (P=0.027). Conclusion Microsurgical resection was a reliable way dealing with complicated hemangioblastoma at posterior cranial fossa. Preoperative DSA and selective embolization provide a good outcome. The pulmonary complications was the most serious and require early intervention.
Objective To explore the microsurgical strategy of complicated hemangioblastoma and evaluate the outcome. Method A retrospective analysis of the clinical data and surgical results was performed in 227 complicated hemangioblastoma at posterior cranial fossa. Result There were 88 solitary and 139 multiple lesions. 32 cases were associated with VHL. The mean diameter of the lesion was (3.23±1.62)cm. The most common location was medulla oblongata and the most common symptom onset was headache and dizziness (37.1%). 132 patients underwent DSA and the embolization of feeding artery was performed in 53 patients. The gross total resection was achieved in 224 patients and subtotal resection in 3 patients. 18 patients underwent the V-P shunt and 27 patients underwent tracheotomy. The pulmonary complications was the most serious complications leading to 3 death. The preoperative KPS was 84.21±8.67 while the last follow-up KPS was 92.73±10.19, which was different in significant (P=0.027). Conclusion Microsurgical resection was a reliable way dealing with complicated hemangioblastoma at posterior cranial fossa. Preoperative DSA and selective embolization provide a good outcome. The pulmonary complications was the most serious and require early intervention.