颅内胆脂瘤诊断和显微手术治疗.docVIP

颅内胆脂瘤的诊断与显微手术治疗 章翔　张剑宁　傅洛安　费舟　顾建文　张志文　刘卫平　王占祥　李安民　宋少军　易声禹 　　摘　要：目的　提高颅内胆脂瘤的诊断水平与手术治疗效果。方法　总结分析218例颅内胆脂瘤的临床征象、诊断方式、显微手术入路与疗效。结果　203例(93.1%)肿瘤获全切除，余15例(6.9%)因肿瘤包膜与丘脑或脑干粘连紧密而行次全切除。5例(2.3%)于手术后2周内因脑干缺血、水肿或肺部感染死亡。176例获长期随访(平均5.6年)，其中170例(96.6%)恢复良好，3例(1.7%)肿瘤有复发，需行再次手术切除。结论　采用CT或MRI进行诊断并用显微手术治疗颅内胆脂瘤，是一种行之有效的方法。　　关键词：胆脂瘤颅内；显微手术；治疗 Diagnosis and Microsurgical Treatment of the Intracranial CholesteatomaZHANG Xiang ZHANG Jian-ning, Fu Luo-an，et alDepartment of Neurosurgery,Xijing Hospital,The Fourth Military Medical University,Xian 710032 　　Abstract:Objective To improve the diagnostic level and surgical curative effect of the intracranial cholesteatoma. Methods Analyse and summarize the clinical materials included the clinical main manifestations,diagnostic modes,microsurgical approach,and outcome of 218 patients with the intracranial cholesteatoma. Results There were 203 cases(93.1%)total removal of the tumor.In the remaining 15 patients(6.9%)，adhesion tightly to the thalamus or brain stem made only subtotal removal of the capsule of tumor. 5 patients were died(2.3%)because of brain stem ischemia or edema,and lung infection within two weeks postoperatively.Long-term follow-up review(mean 5.6 years)in 176 patients revealed good recovery of 170 patients(96.6%),contrasted with a 1.7%(3 cases)late recurrence rate after operations.This patients with recurrence of tumor need to treat by again operative management.Conclusion It is effective method by using the CT or MRI to diagnose and microsurgical technique to remove cholesteatoma for these patients.　　Key words:Cholesteatoma;Intracranial;Microsurgery;Therapy 　　颅内胆脂瘤(Intracranial cholesteatoma,ICC)较少见，由胚胎神经管发育过程中残留的皮肤组织发展而成［1］，发生率约占颅内肿瘤的2%，部位以颅后窝小脑桥脑角区多见。由于此瘤具有生长缓慢、且多发生在颅内中线结构的脑底部蛛网膜下腔，因此早期很少出现临床症状［2］。近21年来，我院对218例ICC采用显微手术治疗，疗效满意，本文对其诊断及显微手术方法作一介绍。 1　材料与方法1.1　一般资料　自1977年1月至1998年1月，共收治ICC218例。男131例(60.1%)；女87例(39.9%)。年龄5～74岁，平均42.3岁，其中≤15岁19例(8.7%)；16～30岁64例(29.3%)；31～45岁90例(41.3%)；46～60岁35例(16.1%)；≥61岁10例(4.6%)。病程4.3月～18.