老年患者乙状窦后进路桥小脑角手术的围手术期处理

The Perioperative Treatment of Cerebellopontine Angle Surgery by Retrosigmoid Approadl in the Elderly Patients

目的总结45例60岁以上老年患者行乙状窦后进路桥小脑角手术的围手术期治疗经验。方法对我科1991年1月至2000年1月行该手术治疗的45例老年患者进行回顾性分析。其中三叉神经痛37例;舌咽神经痛3例;半面痉挛4例;桥小脑角胆脂瘤1例。术前检查异常的有:心电图12例,占26.67%;胸部X线6例,占13.3%;颅脑CT 2例,占4.44%,高血压病9例,占20%;糖尿病5例,占11.1%;肝功能异常3例,占6.67%;白细胞低2例,占4.44%;血小板减少2例,占4.44%。结果所有患者均顺利完成手术,术后无严重并发症,均治愈出院,随访2～9年,症状无复发。结论老年患者虽然体质较弱,检查结果异常多,但只要正确处理围手术期的异常,提高手术技巧,老年患者完全能够耐受此类手术并顺利康复。

Purpose To summarize the perioperative therapeutic experience from forty five patients of over 60 years old who underwent cerebellopontine angle( CPA) surgery by retrosigmoid approach. Methods 45 elderly patients of CPA operation by retrosigmoid approach from Jan. 1991 to Jan 2000 were analyzed retrospectiely. Among them,there were 37 cases of trigeminal neuralgia, 3 of glossopharyngeal neuralgia, 4 of hemifacial spasm and 1 of cerebellopotine angle cholesteatoma. Among the abnomalities of preoperative examinations,there were 12 cases(26.67%) by electrocardiogram,6 cases(13.3%) by thoracic x-ray and 2 cases (4.44%) by cranial CT and hypertension in 9 cases (20%) diabetes in 5 cases (11.1%), abnomalities of liver function in 3 cases (6.67%), leufcopenia in 2 cases (4.44%)and thrombo-cytopenia in 2 cases (4.44%). Results All patients were successfully operated on. No severe postoperative complications were found, when these cases were cured and discharged. There were no recurrences during the follow-up 2 - 9 years. Conclusions Although they were in poor health and presented more abnomalities of preoperative examinatons. the elderly patients could fully bear the operation and successfulhy recover as long as the abnomalities during perioperative period were correctly handled and surgical skills were improved.