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目的:评价显微外科手术不同入路治疗颅脑肿瘤疗效,总结治疗经验。方法:选取2009年1月至2015年10月垫江县中医院共以不同入路治疗颅脑肿瘤患者81例,冠状切口入路、经翼点或扩大翼点入路、后正中或旁正中、乙状窦后入路、第脑中线弧形切口纵裂入路、额下入路等,据肿瘤部位、大小选择合适的切除策略。结果:肿瘤全切率87.65%,并发症发生率18.52%,手术治疗效果显效69.14%、有效27.16%、微效2.47%、无效1.23%;随访5~27个月,复发6.17%,胶质瘤死亡4例;高颅内压症状、癫痫缓解率100.00%,脑神经功能症状缓解率86.27%,语言、运动与感觉功能障碍缓解率表76.47%,未见无效者。不同入路全切率比较,差异无统计学意义(P>0.05),冠状切口入路大部分切除9.52%(2/21)、经翼点或扩大翼点入路0.00%(0/6)、后正中或旁正中8.33%(1/12)、乙状窦后入路20.00%(2/10)、脑中线弧形切口纵裂入路20.00%(1/5)、额下入路14.81%(4/27)。结论:显微外科手术不同入路治疗颅脑肿瘤整体疗效较好,切除率与手术入路无明显相关性,切除率与肿瘤大小类型关系更密切,大型特大型复杂恶性肿瘤预后相对较差。
Objective: To evaluate the curative effect of craniocerebral tumor treated by different microsurgical approaches and to summarize the experience of treatment. Methods: From January 2009 to October 2015, a total of 81 patients with craniocerebral tumor treated by Dianjiang Hospital of Traditional Chinese Medicine underwent coronaries incision through the wing point or enlarged pterional approach, , Sigmoid sinus posterior approach, the first midline incision longitudinal incision approach, the amount of the next approach, according to the tumor site, select the appropriate size of the removal strategy. Results: The total tumor resection rate was 87.65%, the complication rate was 18.52%. The effective rate of surgical treatment was 69.14%, effective rate was 27.16%, slight effect was 2.47%, invalid rate was 1.23%. The recurrence rate was 6.17% Death in 4 cases; high intracranial pressure symptoms, epilepsy remission rate 100.00%, remission rate of brain neurological symptoms 86.27%, language, exercise and sensory dysfunction response rate 76.47%, no ineffective. There was no significant difference in total cut rates between different approaches (P> 0.05). Most of the resected coronal incisions were done in 9.52% (2/21) of the resections, and 0.00% (0/6) , 8.33% (1/12) in the posterior median or posterior midline, 20.00% (2/10) in the sigmoid sinus posterior approach, 20.00% (1/5) in the medial midline incision longitudinal incisors and 14.81 % (4/27). Conclusion: The overall effect of microsurgery for the treatment of craniocerebral tumor is better. There is no significant correlation between resection rate and surgical approach. The resection rate has a close relationship with tumor size and type. The prognosis of large extra large complicated malignant tumors is relatively poor.