兰州大学机构库 >学院待认领
小脑延髓裂入路相关显微解剖及其临床应用
Alternative TitleMicroanatomy study and clinical application of transcerebellomedullary fissure approach
乔栎
Thesis Advisor张新定
2009-05-22
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword小脑延髓裂入路 显微解剖 下蚓部入路 外科入路 临床应用
Abstract目的 研究经小脑延髓裂入路(transcerebellomedullary fissure approach)相关的显微解剖结构和毗邻关系,在不切开下蚓部情况下,分离小脑延髓裂(CMF)获得最充分的术野。切除小脑延髓裂、桥脑、第四脑室周围占位病变。为指导临床手术提供参考。 方法 应用显微外科解剖技术,对经甲醛固定,血管乳胶灌注的5具成人湿性尸头标本,按不同手术入路逐层解剖,观察相关组织和血管的形态结构和毗邻关系,并做了测量和统计分析。采用小脑延髓裂入路不同切开方法,对小脑延髓裂、四脑室周围、及桥脑部位的占位病变20例进行手术切除,结合切开方式和预后,并对相关病变切除和显露程度进行描述和分析,并对3例典型病例说明。 结果 小脑延髓裂入路,不需切开下蚓部,可完全纵向显露从闩至导水管下口,侧向显露从闩至外侧孔的四脑室底及桥脑背外侧区域。比较小脑下蚓部入路,小脑延髓裂入路纵向显露距离无差别(P>0.05),侧向显露距离明显大于下蚓部入路(P<0.05)。经小脑延髓裂入路,不需切开下蚓部,可清楚暴露从导水管下口至闩的四脑室任何部位,通过外侧隐窝至外侧孔和桥脑背外侧。术中广泛型CMF切开11例,外侧壁型切开7例,外侧隐窝CMF切开2例。病变显露良好者16例(80%),显露不良和显露困难者各2例(10%)。病变全切除10例(50%),次全切除6例(30%),部分切除4例(20%)。出院时GOS预后评分5分者12例(60%),4分者8例(40%),无重残或死亡。术后无新增加的神经功能缺损症状。病理诊断:室管膜瘤6例,星形细胞瘤3例,髓母细胞瘤3例,海绵状血管瘤3例,上皮样囊肿2例,脉络丛乳头状瘤、脑动静脉畸形和血管母细胞瘤各1例。结论 小脑延髓裂入路可充分显露CMF、第四脑室周围、桥脑区域,比较下蚓部入路,显露充分,神经组织损伤小,手术安全性提高。经小脑延髓裂正常解剖间隙到达四脑室周围和桥脑背侧方,临床应用该入路手术可减少神经功能障碍和术后并发症。
Other AbstractObjective To study microanatomy of related structure of transcerello- medullary fissure approach (trans-CMF approach), and refine the trans-CMF approach to obtain an appropriate operative view without splitting the inferior vermis. Methods By method of statisti- cal analysis, We studied the microsurgical anatomy structure by using 5 formalin-fixed,silicone- perfused cadaveric heads specimens. we adopted the trans-CMF approach for use in 20 cases of the lesions located in the foramen of magnum、CMF、fourth ventricle、dorsolateral to the pons and medulla, based on operation method and prognosis ,we describe and analyse degree of resection and exposure of extent relative region, three illustrative cases are presented. Results Trans-CMFapproach provides a sufficient operative view access to fourth ventricle from the aqueduct to the obex, and lateral recesses which open through the foramina of Luschka into dorsolateral to the pons. there are no differences in portrait distance (P>0.05) ,but there are statistically significant differences in lateral distance in comparison with inferior vermis approach (P<0.05). We adopt extensive opening method(11cases), lateral wall opening method(7cases), lateral recess opening method(2cases)by trans-CMF approach. the exposure of lesions region show sufficiency(16cases), localization(2cases) difficulty(2cases), it also shows remove totally( 10cases), remove mostly(6cases), remove partly(4cases). Glasgow outcome scale of the patient after leaving hospital is 5 points(12cases), 4 points(8cases).postoperative pathology have ependymoma(6cases), astrocytoma (3cases), medulloblastoma(3cases), cavernoma(3cases), epidermoid cyst (2cases), Ch Pl papilloma(1case), hemangioblastoma(1case), arterio-venous malformation(1case). Conclusion Trans-CMFapproach provides a sufficient operative view from the fourth ventricle to dorsolateral part of the pons and medulla through normal anatomic spaces and reduces the lesions of nervous tissure , obtaining an appropriate operative view and security.
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Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/222497
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
乔栎. 小脑延髓裂入路相关显微解剖及其临床应用[D]. 兰州. 兰州大学,2009.
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