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目的探讨显微手术治疗累及第四脑室肿瘤的临床效果。方法回顾性分析我院自2014年1月至2017年1月期间收治的52例第四脑室肿瘤患者,其中通过小脑下蚓部入路4例,小脑延髓裂入路34例,联合入路14例。根据术前是否合并梗阻性脑积水者进行分组,A组:合并不同程度梗阻性脑积水者;B组:未合并梗阻性脑积水者。分析比较两组患者术后1 w的KPS(Karnofsky)评分。结果本组肿瘤全切除44例(84.6%),次全切除8例(15.4%)。术后颅内高压总缓解率84.2%,头晕缓解率85.3%,呕吐缓解率94.4%,视力减退缓解率0,吞咽困难缓解率33.3%,共济失调缓解率75.0%。术后1 w的KPS评分结果:B组患者的预后良好率好于A组,差异有统计学意义(P<0.05);随访40例,肿瘤复发2例,死亡1例。结论选择合适的手术入路、良好的手术及对并发症正确的处理,是增强第四脑室肿瘤手术治疗效果的重要因素。术前是否合并脑积水对术后恢复预后有一定影响。
Objective To investigate the clinical effect of microsurgical treatment on the fourth ventricle tumor. Methods Retrospective analysis of 52 cases of fourth ventricle tumors admitted in our hospital from January 2014 to January 2017, including 4 cases of cerebellar vermis, 34 cases of cerebellomedullary medulla oblongata, combined approach 14 example. According to whether preoperative combination of obstructive hydrocephalus were grouped, A group: with varying degrees of obstructive hydrocephalus; B group: unobstructed hydrocephalus. The Karnofsky score of 1 w after operation was analyzed and compared between the two groups. Results Totally 44 cases (84.6%) underwent total resection and 8 cases (15.4%) underwent subtotal resection. Postoperative intracranial hypertension total remission rate 84.2%, dizziness remission rate 85.3%, vomiting relief rate 94.4%, vision loss remission rate 0, dysphagia relief rate 33.3%, ataxia relief rate 75.0%. The KPS score at 1 week after operation showed that the good prognosis of group B was better than that of group A (P <0.05). Follow-up was performed in 40 cases, with 2 cases of tumor recurrence and 1 case of death. Conclusion Choosing the appropriate surgical approach, good operation and the correct treatment of complications is an important factor to enhance the surgical treatment of the fourth ventricle tumor. Preoperative hydrocephalus on the prognosis of postoperative recovery has a certain impact.