面神经瘤27例临床分析VIP免费

·4··llfi_i床研究·』竺!!!!!!!!!!!!!!型!g!!蔓!!!堕!!!璺!堡!壁!!!!!!』!里!!!!!Y竺!!!!堕!!面神经瘤27例临床分析张帆1王宇澄1戴春富1迟放鲁1周梁1陈兵1李华伟1[摘要]目的：分析lli『神经瘤患者的临床表现和诊断，讨论不同部位面神经瘤手术方法的选择。方法：对1999—09—2006—12临床资料完整的27例面神经瘤患者进行回顾性研究。结果：27例面神经瘤患者经术后病理证实20例为面神经鞘膜瘤(74．1％)，4例为面神经纤维瘤(14．8％)，3例为面神经血管瘤(11．1％)。病程中表现为面瘫23例(85．2％)；听力卜．降和耳鸣各11例(40．7％)；表现为耳下肿块，且有耳痛、眩晕、耳闷、面部麻木、抽搐5例(18．5％)。24例(88．9％)CT或MRI提示为面神经来源肿瘤。24例(88．9％)累及2个或2个以上的面神经节段，其中累及乳突段处占87．5％(21／24)，累及鼓室段处占70．8％(17／24)，累及膝状神经节处占62．5％(15／24)，累及内耳道占4．2％(1／24)；只累及面神经的1个节段占11．1％(3／27)。27例均手术完整切除肿瘤，其中13例进行了同期面神经霞建术，包括11例腓肠神经移植术，1例面一舌下神经吻合术，1例面神经端端吻合术。2例在切除肿瘤的同时保留了面神经解剖结构的完整性。结论：面神经瘤是一种较少见的良行肿瘤，临床症状多样，CT、MRI等影像学检查有助于术前的讵确诊断，可根据患者的不同情况决定手术治疗的时间及方式。[关键词]面神经肿瘤；面瘫；影像学检查；神经重建[中图分类号]R745．1[文献标志码]A[文章编号]1001—1781(2010)01—0004-04Clinicalexperienceinfacialnervetumors：Areviewof27casesZHANGFanwANGYuchengDAlChunfuCHIFangluZHOULiangCHENBingLIHuawei(Departmentof0t01aryngology，EyeEarNoseThroatHospitalofFudanUniversity，Shanghai，200031，China)Correspondingauthor：WANGYucheng(Email：wychl99771@yahoo．eom．cn)Abstract0bjective：Toanalyzetheclinicalmanifestationsandthediagnosisofthefacialnervetumoraccord—ingtOtheclinicalinformation．andevaluatethedifferentsurgicalapproachesdependingontumorlocation．Method：Twenty-sevencasesoffacialnervetumorswithgeneralclinicalinformationsavailablefrom1999．9tO2006．12intheShanghaiEENTHospitalwerereviewedretrospectively．Result：Twenty(74．1％)schwannomas，4(14．8％)neuofibromas，and3(11．1％)hemangiomaswereidentifiedwithhistopathologypostoperatively．Duringthecourseofthedisease。23patients(85．2％)sufferedfacialparalysis，bothhearinglossandtinnitusaffected11(40．7％)ca—ses。5(18．5％)manifestedinfra—auricularmassandtheothersshowedsomeofotalgiaorvertigoorearfullnessorfacialnumbness／twitched．CTor／andMRIresultsin24casesindicatedthatthetumorsoriginatedfromthefacialnerve．Intra—operativefindingsshowedthat24(88．9％)easesinvolvednolessthan2segmentsofthefacialnerve。ofthese24cases87．5％(21／24)involvedthemastoidprotion，70．8％(17／24)involvedthetympanicprotion，62．5％(15／24)involvedthegeniculateganglion。only4．2％(1／24)involvedtheinternalacousticcanal(IAC)，and3cases(11．1％)hadonlyonesegmentsinvolved．Inallofthese27cases，thetumorswerecompletelyexcised，ofwhichl3wereresectedfollowedbyanimmediatefacialnervereconstruction．including11suralnervecablegraft。1facialnerveend—to-endanastomosisand1hypoglossalfacialnerveend—to-endanastomosis．Tumorswereremovedwithpreservationoffacialnervecontinuityin2cases．Conclusion：Facialnervetumorisarareandbenignlesion，andhasnumerousclinicalmanifestations．CTandMRIcanhelpsurgeonstOmakearightdiagnosispreoperatively．WhenandhowtOgivethepatientsanoperationdependsonthepatientsindividually．Keywordsfacialnervetumor；facialparalysis；imagingexamination；nervereconstruction面神经瘤是一类发病率较低、较少见的肿瘤。多为良...