摘要
目的 总结无牵开器动态牵拉手术临床应用价值及经验.方法 对北京天坛医院2013年11月至2014年10月手术治疗194例无牵开器动态牵拉手术病例进行回顾性研究.分析相关手术入路、病种、神经功能评分、牵拉所致相关并发症.结果 194例中脑血管病127例（65％）,颅内肿瘤67例（35％）,前循环动脉瘤采用额底外侧入路21例,翼点入路39例,后循环小脑后下动脉动脉瘤采用远外侧入路2例.桥小脑角肿瘤采用乙状窦后入路15例,近中线幕上病变采用经前、后纵裂入路11例,后颅窝肿瘤采用枕下后正中入路和旁正中入路20例,岩斜区病变采取颞下入路2例.手术入路周围组织挫伤4例（2％）.二次手术1例（0.52％）,手术后死亡病例2例（1％）.术后神经功能无改变62.3％,改善29.4％,恶化8.24％.结论 熟练掌握规范的显微神经外科技术,采用无牵开器动态牵拉技术手术可以降低神经外科手术术后相关并发症.
Objective A retrospective study was conducted to analyze the clinical data of patients treated by retractorless surgery and explore the clinical feasibility and practical application of this strategy.Methods A total of 194 patients undergone retractorless surgery in Beijing Tiantan Hospital from Nov 2013 to Oct 2014 were retrospectively reviewed.Complications related to microsurgical approaches,disease types,neurological function score and intraoperative compression or stretching were analyzed.Results Of the 194 cases,there were 127 （65%） patients with cerebrovascular diseases and 67 （35%） patients with intracranial tumors.Sixty patients had anterior circulation aneurysms,of them,21 aneurysms were accessed through frontal-lateral approaches and 39 reached via pterional approaches.Two patients with posterior inferior cerebellar artery （PICA） aneurysms were treated by far-lateral approaches.Fifteen patients with cerebellopontine angle （CPA） tumors were treated by retrosigmoid approaches.Elven patients with supratentorial tumors were treated by anterior and posterior interhemispheric approaches.Twenty patients with posterior fossa tumors were treated by suboccipital posterior median and paramedian approaches.Two patients with petroclival region lesions were treated by subtemporal approaches.Damage of tissues surrounding the approach occurred in 4 cases （2%）.One patient received secondary procedures （0.52%） and 2 patients died after operation （1%）.No change of postoperative neurological function was seen in 62.3% of cases,improvement of postoperative neurological function was seen in 29.4% and neurological function deterioration 8.24%.Conclusions Compared with the retractor surgery,retractorless surgery does not increase the rate of damage of tissues surrounding the approach.With the proficiency in microneurosurgery methods,retractorless surgery can reduce the postoperative complications.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第25期1976-1979,共4页
National Medical Journal of China
关键词
脑血管病
颅底肿瘤
牵开器手术
手术并发症
Cerebrovascular disease
Skull base tumor
Retractor Surgery
Operative complication
