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目的总结听神经瘤手术并发症的防治体会,以提高此类手术的疗效和病人术后生存质量。方法2001年至2005年收治听神经瘤119例,应用显微外科技术经枕下乙状窦后入路行肿瘤切除,回顾分析手术并发症的发生情况。结果肿瘤全切除71例,次全切除33例,大部切除15例。手术并发症:吞咽困难、声嘶18例;术后硬膜外血肿2例;CT证实颅内积气2例;肢体活动障碍2例;中枢神经感染2例;伤口感染3例;肺部感染2例;脑脊液切口漏5例;死亡2例;术中面神经解剖保留95例(79.8%),其中术中面神经功能监测组(IFNM)较非监测组明显提高。结论肿瘤大小与肿瘤全切率及面听神经保留率密切相关,掌握CPA正常及异常状态下的解剖结构,正确的切除方法及较全面的神经功能监测,是提高听神经瘤手术治疗疗效的关键。
Objective To summarize the prevention and treatment of surgical complications of acoustic neuroma in order to improve the curative effect of these operations and the postoperative quality of life of patients. Methods From 2001 to 2005, 119 cases of acoustic neuroma were treated. Microsurgical techniques were used to resect suboccipital sigmoid sinus. The incidence of surgical complications was retrospectively analyzed. Results Total tumor resection in 71 cases, subtotal resection in 33 cases, most of the resection in 15 cases. Surgical complications: dysphagia, hoarseness in 18 cases; postoperative epidural hematoma in 2 cases; CT confirmed intracranial gas in 2 cases; limb movement disorders in 2 cases; central nervous system infection in 2 cases; wound infection in 3 cases; pulmonary infection 2 cases; leakage of cerebrospinal fluid in 5 cases; 2 cases of death; facial nerve anatomy retained 95 cases (79.8%), of which intraoperative facial nerve function monitoring group (IFNM) was significantly higher than the non-monitoring group. Conclusions Tumor size is closely related to tumor resection rate and facial nerve preservation rate. To master the normal and abnormal CPA anatomy, proper resection and more comprehensive neurological monitoring are the keys to improve the therapeutic effect of acoustic neuroma.