不同手术入路切除岩斜区肿瘤的临床疗效对比分析

A comparative analysis of the clinical effect of different operation approach for resection of petroclival tumors

目的对比分析采用不同手术入路切除岩斜区肿瘤的临床疗效。方法选取2013年7月到2014年7月手术治疗的100例岩斜区肿瘤患者,根据患者的情况采用不同的手术入路,对患者的临床表现、特征,手术入路的方法,治疗结果以及术后临床并发症进行对比分析。结果经岩骨乙状窦前入路的全切除率、次全切除率,美国国立卫生研究院卒中量表(NIHSS)评分、神经功能缺损评分(CSS)显著好于枕下乙状窦后入路、颞下前岩骨硬膜外入路以及颞下经小脑幕入路,差异有统计学意义(P<0.05);经岩骨乙状窦前入路患者并发颅内感染(14.89%)和听神经麻痹(17.02%)的患者比率明显高于其他三种手术入路方式(均为0%);经枕下乙状窦后入路患者并发皮下积液(12.50%)的患者比率明显高于其他三种手术入路方式(均为0%);经颞下经小脑幕入路并发复视(15.38%)的患者比率明显高于其他三种手术入路方式(均为0%),差异均具有统计学意义(P<0.05)。结论不同位置的岩斜区肿瘤选用适合的手术入路可以提高肿瘤的切除率,减少并发症的发生,有效改善患者的术后恢复程度。经岩骨乙状窦前入路是临床手术入路中临床效果最为显著的治疗手段。

Objective Comparative analysis of resection of petrosaclival tumors with different operation approach clinical effect. Methods One hundred cases of tumor patients received operation treatment in our hospital from July 2013 to July 2014 were included into this study. Ac-cording to the condition of patients,all these patients were given different operation approach,compare and analyze the clinical manifestation, characteristics of the patients,methods of operation approach,treatment outcome and postoperative complications. Results The rate of total resec-tion,subtotal resection rate,NIHSS score,CSS score of trans - petrosal presigmoid approach was significantly better than the suboccipital retrosig-moid approach,subtemporal anterior petrous bone hardmembrane outer approach and subtemporal transtentorial approach. The difference was sta-tistically significant（ P 〈 0. 05）. Trans - petrosal presigmoid approach patients complicated with intracranial infection（14. 89% ）and auditory nerve paralysis（17. 02% ）,which were significantly higher than the proportion of other three kinds of operation ways（both 0% ）. The subcutane-ous effusion rate in via suboccipital retrosigmoid approach patients was 12. 50% ,which was significantly higher than the proportion of other three kinds of operation approach（0% ）. The subtemporal transtentorial approach to concurrent diplopia（15. 38% ）was significantly higher than the proportion of other three kinds of operation ways（0）. The difference was statistically significant（ P 〈 0. 05）. Conclusion The different location of the petroclival region tumor resection rate can be selected to improve the fit of the approach of operation,reduce the incidence of complications, and improve the degree of recovery of patients after surgery. Trans - petrosal presigmoid approach is the most significant clinical operative treatment effect in the road,and has important value in clinical application.