本文選題：神經(jīng)瘤　切入點(diǎn)：聽　出處：《中國人民解放軍醫(yī)學(xué)院》2016年博士論文　論文類型：學(xué)位論文

【摘要】：本課題組近些年來在聽神經(jīng)瘤面神經(jīng)和聽神經(jīng)的功能保留方向進(jìn)行了探索和經(jīng)驗(yàn)總結(jié),本文將從這兩個(gè)方面進(jìn)行闡述。第一部分聽神經(jīng)瘤手術(shù)面神經(jīng)的功能保留目的探討聽神經(jīng)瘤手術(shù)面神經(jīng)功能的保留術(shù)式和影響因素。方法采用隊(duì)列研究方法對(duì)152例聽神經(jīng)瘤患者進(jìn)行手術(shù)切除和術(shù)后面神經(jīng)功能觀察。對(duì)三種手術(shù)入路的面神經(jīng)功能保留結(jié)果進(jìn)行比較。采用Logistic回歸模型分析聽神經(jīng)瘤術(shù)后即刻和長(zhǎng)期的面神經(jīng)功能保留與手術(shù)入路、腫瘤大小、年齡、性別、腫瘤與面神經(jīng)粘連程度等方面的相關(guān)性.結(jié)果在152例聽神經(jīng)瘤患者中,97.4%的患者存在耳聾,88.2%存在耳鳴,眩暈的發(fā)生率為32.2%,面部麻木及皮膚感覺異常24.3%,步態(tài)不穩(wěn)占13.2%,耳痛11.8%,復(fù)視3.9%,飲水嗆咳2.6%。腫瘤的最大直徑平均為2.34±1.14cm。面神經(jīng)解剖保留完整者145例(占95.4%)。術(shù)后第7天經(jīng)迷路入路對(duì)面神經(jīng)功能的保留與經(jīng)乙狀竇后入路和顱中窩入路比較有差別,而經(jīng)乙狀竇后入路和經(jīng)顱中窩入路對(duì)于面神經(jīng)功能的保留無差別。術(shù)后1年三種手術(shù)入路對(duì)于面神經(jīng)功能的保留均無差別。經(jīng)Logistic回歸模型多元分析發(fā)現(xiàn)術(shù)后第7天面神經(jīng)的功能保留與手術(shù)入路和腫瘤與面神經(jīng)的粘連程度有關(guān),與患者年齡、性別、腫瘤大小無關(guān)；術(shù)后1年面神經(jīng)功能的保留與患者年齡、腫瘤與面神經(jīng)的粘連程度有關(guān),與手術(shù)入路、腫瘤大小、性別無關(guān)。結(jié)論1、聽神經(jīng)瘤術(shù)后即刻經(jīng)迷路入路對(duì)于面神經(jīng)功能的保留優(yōu)于經(jīng)乙狀竇后入路和顱中窩入路,而經(jīng)乙狀竇后入路和經(jīng)顱中窩入路對(duì)面神經(jīng)功能的保留無差別.三種手術(shù)入路對(duì)于面神經(jīng)功能的長(zhǎng)期保留均無差別.2、聽神經(jīng)瘤術(shù)后即刻面神經(jīng)的功能保留與手術(shù)入路和腫瘤與面神經(jīng)的粘連程度有關(guān),與患者年齡、性別、腫瘤大小無關(guān)；術(shù)后長(zhǎng)期的面神經(jīng)功能保留與患者年齡、腫瘤與面神經(jīng)的粘連程度有關(guān),與手術(shù)入路、腫瘤大小、性別無關(guān).第二部分聽神經(jīng)瘤聽神經(jīng)的功能保留目的探討聽神經(jīng)瘤聽神經(jīng)功能的保留策略。方法采用隨訪觀察、顯微外科手術(shù)切除、立體定向放射治療對(duì)54名中小聽神經(jīng)瘤患者進(jìn)行個(gè)性化保留聽力的嘗試。 結(jié)果在聽神經(jīng)瘤的聽力保留方面我們隨訪觀察了27名小聽神經(jīng)瘤患者,24名(88.9%,24/27)患者腫瘤生長(zhǎng)緩慢乃至不生長(zhǎng),繼續(xù)觀察隨訪,3例患者因腫瘤增長(zhǎng)過快終止觀察,其中2例患者給予手術(shù)切除,1例患者給予伽瑪?shù)吨委�。這例伽瑪?shù)吨委熁颊?治療后隨訪觀察3年腫瘤沒有增長(zhǎng),聽力得到了很好的保留。課題組還對(duì)29例中小聽神經(jīng)瘤患者進(jìn)行了保留聽力的手術(shù)治療,其中27例采用了經(jīng)乙狀竇后入路,2例采用了經(jīng)顱中窩入路。聽神經(jīng)瘤術(shù)后即刻聽力保留率55.2%(16/29)(A+B級(jí)聽力)。其中,聽力A級(jí)的為7例43.8%(7/16),B級(jí)的為9例56.3%(9/16)。術(shù)前聽力為A級(jí)的患者,術(shù)后即刻聽力保留率為78.6%(A+B級(jí)聽力),其中保留A級(jí)聽力者50.0%(7/14),B級(jí)聽力者28.6%(4/14),C級(jí)者14.3%(2/14),D級(jí)者7.1%(1/14)。術(shù)前B級(jí)聽力的患者,術(shù)后即刻聽力保留率為(33.3%,5/15)(B級(jí)聽力),C級(jí)者53.3%(8/15),D級(jí)者13.3%(2/15)。術(shù)后1-3年隨訪觀察,在術(shù)后即刻保留聽力的16名患者中,有14例87.5%(14/16)術(shù)后聽力保留穩(wěn)定,有2例12.5%(2/16)患者聽力在隨訪的三年內(nèi)出現(xiàn)了下降,分別由A級(jí)降為B級(jí)和由B級(jí)降為C級(jí). 結(jié)論1、患者術(shù)前的聽力級(jí)直接影響手術(shù)的聽力保留率,因此,對(duì)聽神經(jīng)瘤的早發(fā)現(xiàn)、早診斷、早治療,在聽力為A級(jí)時(shí)就及時(shí)地給予手術(shù)是手術(shù)成功保留聽力的關(guān)鍵。2、當(dāng)隨訪觀察的過程中發(fā)現(xiàn)腫瘤體積增長(zhǎng)過快或?qū)嵱寐犃赡芤芸靻适У那闆r下,只要患者的全身情況允許,還是要積極的給予手術(shù)治療,不要優(yōu)柔寡斷地錯(cuò)失保留聽力的最后時(shí)機(jī)。
[Abstract]:The research group in recent years in acoustic neuroma facial nerve and auditory nerve function preservation are explored and summed up the experience, this paper will elaborate on these two aspects. To investigate the factors to the function of facial nerve neuroma surgery reservation operation and influence to reserve the first part function of the facial nerve in acoustic neuroma surgery. Methods by using the method of queue study on the observation of facial nerve function after surgical resection and 152 cases of patients with acoustic neuroma surgery. To compare the results of three surgical approaches to the preservation of facial nerve function. Logistic regression model was used to analyze acoustic neuroma surgery immediately after and long-term preservation of facial nerve function and surgical approach, tumor size, age, gender, tumor correlation with the facial nerve adhesion degree etc.. Results in 152 cases of patients with acoustic neuroma, 97.4% were deaf, 88.2% tinnitus, vertigo occurred in 32.2% face Department of numbness and paresthesia in 24.3%, gait instability accounted for 13.2%, 11.8% and 3.9% earache, diplopia, hydroposia 2.6%. average tumor diameter was 2.34 + 1.14cm. facial nerve intact in 145 cases (95.4%). After seventh days the translabyrinthine approach retains the function of facial nerve and retrosigmoid approach and middle cranial fossa are different, and by retrosigmoid approach and retention by middle fossa approach for facial nerve function showed no difference. 1 years after the operation of three kinds of surgical approach for facial nerve function preservation was not different. By Logistic regression model in operation after seventh days of facial nerve function preservation and adhesion degree of surgical approach and tumor and facial nerve, gender and age of patients, regardless of tumor size, patient age 1 years; retention and postoperative facial nerve function, the degree of adhesion of tumor and facial nerve associated with surgical approach, tumor The size, regardless of gender. Conclusion 1, acoustic neuroma surgery immediately after the reservation is better than the translabyrinthine approach for facial nerve function by retrosigmoid approach and middle cranial fossa, and by retrosigmoid approach and retention of the middle cranial fossa of facial nerve function had no difference between the three kinds of operation. Approach for long-term retention of facial nerve function showed no significant difference in.2, acoustic neuroma surgery after facet nerve function associated with the degree of adhesion retention of surgical approach and tumor and facial nerve, gender and age of patients, tumor size, independent; postoperative long-term preservation of facial nerve function and the age of patients, the degree of adhesion and tumor the facial nerve associated with surgical approach, tumor size, regardless of gender. The second part acoustic neuroma auditory nerve Objective: To investigate the function of acoustic neuroma hearing preservation strategy of neural function preserving. Methods observation, microsurgical resection and stereotactic radiotherapy The treatment of 54 patients with acoustic neuroma and personalized hearing preservation attempt. Results in acoustic neuroma hearing preservation we observed 27 small acoustic neuroma patients, 24 (88.9%, 24/27) in patients with tumor growth and even slow growth, continue to observe the follow-up, 3 patients with tumor growth termination observation of which 2 cases were treated with surgical resection, 1 cases were treated with gamma knife treatment. The cases of gamma knife in the treatment of patients with follow-up after treatment for 3 years without tumor growth, hearing is well preserved. The research group of 29 cases and listen to the tumor patients underwent surgery to preserve hearing, of which 27 cases were treated with the retrosigmoid approach, 2 cases by middle cranial fossa. Acoustic neuroma surgery immediately after hearing preservation rate was 55.2% (16/29) (grade A+B hearing). Among them, a hearing for 7 cases of 43.8% (7/16), B grade 9 cases 56.3% (9/16) before operation. 鍚姏涓篈綰х殑鎮(zhèn)ｈ，

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