【摘要】：目的:通過觀察比較對(duì)小腦扁桃體下疝I型(CM-I)患者分別采用神經(jīng)內(nèi)鏡與顯微鏡下行單純寰枕減壓術(shù)的療效,探討二種術(shù)式各自的優(yōu)勢(shì)和不足,為臨床CM-I型最佳手術(shù)方式的選擇提供依據(jù)。方法:收集整理山西省人民醫(yī)院神經(jīng)外科從2007年1月到2016年1月共96例首診CM-I患者的臨床資料,根據(jù)手術(shù)方式選擇的不同分為神經(jīng)內(nèi)鏡下寰枕減壓術(shù)組和顯微鏡下寰枕減壓術(shù)組);對(duì)比兩組患者術(shù)前臨床體征,術(shù)中手術(shù)相關(guān)數(shù)據(jù)和術(shù)后恢復(fù)情況,并對(duì)相關(guān)資料進(jìn)行分析比較。計(jì)量資料使用t檢驗(yàn)處理,c2檢驗(yàn)用來檢驗(yàn)計(jì)數(shù)資料,P0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果:本組手術(shù)病例無死亡和嚴(yán)重并發(fā)癥。其中內(nèi)鏡手術(shù)組42例,癥狀改善40例(95.2%),癥狀不變2例(4.8%)。顯微手術(shù)組54例,癥狀改善48例(88.9%),癥狀不變6例(11.1%)。出院后隨訪:通過電話、短信、門診復(fù)查、郵件等手段回訪,回訪時(shí)間半年-5年。SPSS17.0軟件處理數(shù)據(jù),內(nèi)鏡手術(shù)的患者在手術(shù)時(shí)間、術(shù)中失血量、住院費(fèi)用等指標(biāo)均優(yōu)于顯微手術(shù)組,采用卡方檢驗(yàn)可得P值0.05,有統(tǒng)計(jì)學(xué)意義。按照CCOS評(píng)價(jià)內(nèi)鏡組顯微鏡組手術(shù)效果和并發(fā)癥對(duì)比,采用卡方檢驗(yàn)可得P值0.05,兩者差異無顯著性。結(jié)論:對(duì)于治療ChiariⅠ型的寰枕減壓手術(shù),不論顯微鏡下操作,或內(nèi)鏡下手術(shù),均能取得寰枕減壓的效果。但內(nèi)鏡下寰枕減壓手術(shù)更加微創(chuàng),對(duì)寰枕部穩(wěn)定性影響小,且住院時(shí)間短,住院費(fèi)用低。
[Abstract]:Objective: to observe and compare the effects of simple decompression of occipital atlanto under neuroendoscopy and microscope in patients with type I (CM-I) subtonsillar hernia of cerebellum, and to explore the respective advantages and disadvantages of the two methods. To provide the basis for the selection of the best operation mode of clinical CM-I type. Methods: the clinical data of 96 patients with CM-I in Shanxi Provincial people's Hospital from January 2007 to January 2016 were collected and analyzed. According to the choice of surgical methods were divided into endoscopic atlantooccipital decompression group and microscopically atlantooccipital decompression group); The preoperative clinical signs, intraoperative data and postoperative recovery were compared between the two groups. The measurement data were processed by t test, and the count data were checked by c 2 test, P 0.05 was statistically significant. Results: there were no death and serious complications in this group. There were 42 cases in endoscopic surgery group, 40 cases (95.2%) were improved and 2 cases (4.8%) were unchanged. In the microsurgery group, the symptoms were improved in 48 cases (88. 9%) and unchanged in 6 cases (11. 1%). Follow up after discharge: by telephone, short message, outpatient review, mail and other means, the return visit time is 6 months to 5 years. SPSS17.0 software processing data, endoscopic surgery patients in the operation time, intraoperative blood loss, The cost of hospitalization was better than that of microsurgery group, P value was 0.05 by chi-square test, which had statistical significance. According to the CCOS evaluation of the endoscopic group microscope group operation results and complications, chi-square test was used to obtain P value 0.05, there was no significant difference between the two groups. Conclusion: global occipital decompression can be achieved either under microscope or under endoscope for the treatment of Chiari type I atlantooccipital decompression. But endoscopic occipital decompression is more minimally invasive and has little effect on the stability of occipital part, short hospitalization time and low hospitalization cost.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.1

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