张训

【摘要】 目的 分析神经内镜辅助后颅窝显微神经外科手术治疗脑肿瘤的临床效果。方法 40例后颅窝脑肿瘤患者， 随机分为对照组和观察组， 每组20例。对照组采取常规开颅显微手术进行治疗， 观察组采取神经内镜辅助后颅窝显微神经外科手术进行治疗。观察两组患者临床效果。结果 观察组患者全切除率85%高于对照组的55%， 大部分切除率15%低于對照组的45%， 差异具有统计学意义（P<0.05）。观察组患者术后生活质量评估分级：Ⅰ级18例， Ⅱ级1例， Ⅲ级1例， Ⅳ级0例;对照组患者术后生活质量评估分级：Ⅰ级13例， Ⅱ级5例， Ⅲ级2例， Ⅳ级0例。观察组术后生活质量评估分级明显优于对照组， 差异具有统计学意义（P<0.05）。观察组并发症发生率为10%低于对照组的15%， 但差异无统计学意义（P>0.05）;观察组颅神经损害率为10%低于对照组的40%， 差异具有统计学意义（P<0.05）。结论 神经内镜辅助后颅窝显微神经外科手术治疗脑肿瘤， 可有效提升肿瘤全切除率， 提高患者术后生活质量， 降低颅神经损害率， 值得临床推广应用。

【关键词】 神经内镜;后颅窝;显微神经外科手术;脑肿瘤

DOI：10.14163/j.cnki.11-5547/r.2020.20.002

【Abstract】 Objective   To analyze the clinical effect of neuroendoscopy assisted microneurosurgery of posterior cranial fossa on brain tumors. Methods   A total of 40 brain tumors patients were randomly divided into control group and observation group， with 20 cases in each group. The control group was treated by conventional （micro） craniotomy surgery， and the observation group was treated by neuroendoscopy assisted microneurosurgery of posterior cranial fossa. The clinical effect of the two groups was compared. Results   The total resection rate 85% of the observation group was higher than that of the control group 55%， and majority resection rate 15% was lower than that of the control group 45%， and the difference was statistically significant （P<0.05）. Postoperative quality of life assessment grades in observation group： 18 cases in grade Ⅰ， 1 case in grade Ⅱ， 1 case in grade Ⅲ， and 0 case in grade Ⅳ; postoperative quality of life assessment in control group： 13 cases in grade Ⅰ， 5 cases in grade Ⅱ， 2 cases in grade Ⅲ and 0 case in grade Ⅳ. The postoperative quality of life assessment grades of observation group was obviously better than that of the control group， and the difference was statistically significant （P<0.05）. The incidence of complications of the observation group was 10%， which was lower than that of the control group 15%， but the difference was not statistically significant （P>0.05）. The cranial nerve damage rate of the observation group was 10%， which was lower than that of the control group 40%， and the difference was statistically significant （P<0.05）. Conclusion   Neuroendoscopy assisted microneurosurgery of posterior cranial fossa on brain tumors can effectively improve the total resection rate， improve the postoperative quality of life of patients， and reduce the rate of cranial nerve damage， which is worthy of clinical promotion and application.

【Key words】 Neuroendoscopy; Posterior cranial fossa; Microneurosurgery; Brain tumors

后颅窝受解剖结构影响， 手术难度较高， 术后患者容易发生并发症， 影响预后效果。近年来， 随着神经内镜在临床广泛推广， 并在脑池、脑室、前中颅底、中线区域等部位肿瘤手术中取得良好效果， 但目前关于后颅窝肿瘤治疗报道较少。本研究特收集本院收治的40例脑肿瘤患者为研究对象， 对神经内镜辅助后颅窝显微神经外科手术治疗效果进行分析， 现报告如下。

1 资料与方法

1. 1 一般资料 选取2017年1月～2019年12月本院收治的40例脑肿瘤患者， 纳入标准：①患者影像学检查均与脑肿瘤（桥小脑角胆脂瘤、听神经瘤、四脑室胆脂瘤、小脑幕脑膜瘤）相关诊断标准符合;②术前未接受伽马刀及其他放射治疗;③患者及家属均对研究内容知情， 自愿参与此次研究且已签署知情同意书。排除标准：①免疫系统性疾病;②凝血功能障碍;③药物过敏;④心脏病、肝肾疾病及其他严重器官疾病;⑤精神疾病、沟通、认知功能障碍;⑥无法全程配合研究者。……