后颅窝小骨窗减压扩容联合术式治疗ChiariⅠ型畸形:与其他术式比较

Posterior fossa decompression combined with tonsillectomy and lysis of low part of the fourth ventricle via small-size craniotomy for Chiari type Ⅰ malformation:comparison with other operative method

目的探讨治疗ChiariⅠ型畸形最佳手术策略和方式。方法 102例ChiariⅠ型畸形患者分别采用三种术式治疗。第一种术式:后颅窝小骨窗减压,联合下疝小脑扁桃体处理、第四脑室下端松解术,治疗70例(68.6%);第二种术式:常规大骨窗后颅窝减压加小脑扁桃体下疝复位,治疗21例(22.6%);第三种术式:后颅窝常规减压联合小脑扁桃体下疝复位,加脊髓空洞蛛网膜下腔分流,治疗11例(10.8%)。对3种术式的的手术效果和并发症进行统计学分析。结果术后近期(术后6月以内)症状消失或减轻84例(82.35%)。远期(术后6个月以上)随访88例(第一、二、三种术式治疗组分别为66例,14例和8例),症状消失或减轻76例(86.4%),其中第一种术式治疗组63例(95.5%,63/66);第二种术式治疗组8例(57.1%,8/14),第三种术式治疗组5例(62.5%,5/8),第一种术式的治疗效果与后两种方式比较,差异显著(P<0.01);第一、二、三种术式治疗组并发症发生率分别为7.6%(5/66),42.9%(6/14)和37.5%(3/8)。第一种术式治疗并发症发生率明显低于其余2组(P<0.05)。结论第一种术式治疗ChiariⅠ型畸形疗效确切,并发症少。

Objective To explore the better surgical method to treatmeat of Chiari type Ⅰ malformation.Methods Of 102 patients with Chiari type Ⅰ malformation undergoing the surgical treatment,70 underwent Small-sized craniotomy for posterior fossa decompression combined with tonsillectomy and lysis of low part fourth （SCPDTL）,21 did routine large-sized craniotomy for posterior fossa decompression combined with tonsillectomy （LCPDT） and 11 did large-sized craniotomy for posterior fossa decompression combined with reduction of tonisllar hernia and syringomyelic-subarachnoid shunt （LCPDRTHSS）.The curative effects were analyzed and compared each other.Results The clinical symptoms were relieved in 84 patients （82.4%） 6 months after the operation.Of 88 patients who were followed up from more than 6 months to 10 years,66 were in SCPDTC group,14 in LCPDT group and 8 in LCPDRTHSS group.The rates of the clinical symptoms improvement were 95.5% （63/66）,57.1%（8/14） and 62.5（5/8） respectively in SCPDTL,LCPDT and LCPDRTHSS groups.The rate of the clinical symptoms improvement was significantly higher in SCPDTL group than those in LCPDT and LCPDRTHSS groups （P0.01）.The rates of the postoperative complications were 7.6%（5/66）,42.9%（6/14） and 37.5%（3/8） respectively in SCPDTL,LCPDT and LCPDRTHSS groups.The rates of the postoperative complications was significantly lower in SCPDTL group than those in the other two groups （P0.05）.Conclusion The curative effect of SPDTL on Chiari type Ⅰ malformation is better than those of LCPDT and LCPDRTHSS.