摘要
目的:探讨老年人大型听神经瘤的特点、围手术期处理与微侵袭治疗策略。方法:总结2000年以来手术治疗的12例老年患者大型听神经瘤的临床特点,采用显微微创手术、加强围手术期监测与治疗,术后结合放射治疗的个体化治疗策略,总结其预后。结果:12例老年患者大型听神经瘤手术时间最短3 h,最长5.2 h,平均手术时间4.1 h。肿瘤全切3例中面神经保留2例;近全切除8例和大部切除1例中,面神经全部得以保留。术后死亡1例(肿瘤全切患者)。8例患者进行了γ刀补充治疗。11例患者得到1.5年以上随访,肿瘤控制率为100%。结论:对于老年大型听神经瘤患者,重视围手术期处理有助于降低并发症和死亡率。手术治疗应采用微创理念,强调保留术前神经功能,保证生存质量,不应以牺牲神经功能为代价强调全切。
Objective： To investigate the clinical characteristics of the elderly patients with large CPA （Cerebello -Pontine Angle） acoustic neuromas and to discuss the effects of individuallized mini invasive surgical strategy for the elders. Methods： Twelve patients over 60 years old with large CPA acoustic neuromas were received mini invasive surgical procedures and 8 of them（ whose tumors not totally removed） also received γ- knife radiotherapy. 11 patients were followed -up and the results were summarized. Results： In the 12 cases of surgical procedures, the operation time was between 3 hours to 5.2 hours, with a mean - time of 4.1 hours. Tumors were totally removed in 3 patients with the facial nerves reserved in 2 of them. In the other 9 patients whose tumors were subtotally removed, all the facial nerves reserved. 1 patient died from worsened bulboparalysis symptoms and lung infection 3 weeks after operation. Among the 9 patients whose tumors were not totally removed, 8 received γ- knife radiotherapy within l month after operation. All the 11 patients were followed - up at 1. 5 years after operation, 4 tumors dissapeared,4 atrophied and 3 remained unchange. Conclusion： For elder patients with large acoustic neuromas, the pre-and post-operative treatments should be especially emphasized for reducing the rate of postoperative complications and mortality. The mini-invasive principles and the microsurgery techniques must be followed to preserve the neurologic functions and living qualities. Neurologic functions should not be sacrificed when chasing for ＂tumors totally resection＂.
出处
《海南医学院学报》
CAS
2008年第4期392-394,共3页
Journal of Hainan Medical University
关键词
听神经
肿瘤
面神经
显微外科手术
老年人
Acoustic nerve
Neoplasa
Facial nerve
Microsurgery
Elderly people
