论文部分内容阅读
目的:分析颈静脉孔区肿瘤术后后组脑神经损伤情况及其处理,以提高对后组脑神经损伤的认识并改进处理方法。方法:32例颈静脉孔区肿瘤患者中,颈静脉球体瘤12例,后组脑神经鞘膜瘤10例,脑膜瘤3例,胆脂瘤1例,颞骨巨细胞瘤2例,纤维瘤病1例,黏液软骨肉瘤1例,胚胎型横纹肌肉瘤1例,腺样囊性癌1例。均采取手术治疗,30例全切,1例近全切,1例大部切除。结果:除1例术后并发颅内出血死亡外,其余31例术后随访1~6年。术后后组脑神经功能仍正常者5例,新出现神经功能损伤者8例,原有神经功能损伤者18例术后出现不同程度的损伤加剧表现。手术前后行气管切开者8例,其中3例出院前拔管,5例带管出院。出院时后组脑神经损伤代偿者20例,失代偿者6例。失代偿者术后随访中3例代偿,2例部分代偿,1例未代偿。结论:颈静脉孔区肿瘤术后后组脑神经损伤是常见并发症,术前应根据患者年龄、神经功能等综合评估,术中应尽量保全神经,早期积极正确的功能锻炼是术后处理的关键。
OBJECTIVE: To analyze the injury and treatment of cranial nerves in the posterior jugular fossa after operation in order to improve the cognition of cranial nerve injury in the latter group and to improve the treatment method. Methods: Thirty-two cases of jugular foramen tumors were treated with 12 cases of jugular bulb tumor, 10 cases of posterior cranial nerve sheath tumor, 3 cases of meningioma, 1 case of cholesteatoma, 2 cases of temporal giant cell tumor, 1 case, mucinous chondrosarcoma in 1 case, embryonal rhabdomyosarcoma in 1 case, adenoid cystic carcinoma in 1 case. All cases were treated by surgery, 30 cases were cut completely, 1 case was nearly totally cut, and 1 case was mostly resected. Results: Except one case died of intracranial hemorrhage, the remaining 31 cases were followed up for 1-6 years. In the postoperative group, there were 5 cases with normal brain function, 8 cases with new neurological injury, and 18 cases with original neurological injury. Tracheotomy was performed in 8 patients before and after surgery, of which 3 were extubated before discharge and 5 were discharged. After discharge, 20 cases were compensated for cranial nerve injury in the latter group, and 6 cases were decompensated. In the follow-up, 3 cases were decompensated, 2 cases partially compensated, and 1 case was not compensated. CONCLUSION: Cerebral nerve injury in the posterior jugular fossa is a common complication after operation, and should be evaluated preoperatively according to the age and neurological function of the patient. The nerve should be preserved in the operation as far as possible. The positive and correct early functional exercise is the postoperative treatment The essential.