侧颅底肿瘤术中颈静脉球的静脉窦回流临床研究

Occlusion of Venous Sinuses Reduces Bleeding during Resection of Skull Base Tumor Involving Jugular Bulb

目的观察侵犯颈静脉球的侧颅底肿瘤术中的静脉窦回流关系。方法回顾性分析我院自2010年1月至2013年6月收治的7例侵犯颈静脉球的侧颅底肿瘤,其中颈静脉球体瘤5例;侵犯颈静脉球的颞骨鳞癌1例;后颅窝脑膜瘤1例。手术方式采用颞下窝入路,以填塞法或者结扎法控制乙状窦,于颈部结扎颈内静脉。切开颈静脉球,填塞汇入的静脉窦开口,并连同受累静脉壁一起切除肿瘤。结果颈静脉球内静脉窦汇入关系如下:单口汇入4例;双口汇入者2例;数个小口汇入者1例。颈静脉球体瘤完整切除3例,部分切除2例,术后出现暂时性后组颅神经麻痹者1例;中耳癌1例完整切除;脑膜瘤1例完整切除。结论了解颈静脉球及邻近血管腔的静脉窦回流关系,并予以填塞,对于侵犯颈静脉球的侧颅底肿瘤手术切除和出血控制有着重要的意义。

Objectives To study afflux of venous sinuses into the jugular bulb, and operational techniques that allow both total tumors and proper control bleeding during the operation. Methods The study analyzed 7 cases of skull base tu-mors that involved the jugular bulb treated from January, 2010 to June, 2013 in our department, including glomus jugular tu-mor （n=5）, malignant temporal bone tumor （n=1） and meningioma （n=1）. All the cases were operated upon via an infratempo-ral fossa approach. After ligation of the jugular vein in the neck and sigmoid sinus, the jugular bulb was incised to expose and occlude the orifice of vein sinuses. The tumor was removed together with the involved jugular bulb. Results The number of or-ifices of venous sinuses draining into the jugular bulb could be single （n=4）, double （n=2） or more than two （n=1）. Total tumor resection was achieved in 3 cases of the 5 glomus jugular tumor cases and partial resection in the rest 2. Total tumor removal was achieved in the malignant temporal bone tumor and meningioma cases. Conclusion It is very important to understand the afflux of venous sinuses into the jugular bulb. Blocking venous sinuses orifices can help control bleeding and tumor resection.