经眉弓微骨窗入路显微手术切除鞍区肿瘤46例

韦耀刚　张永福　周逸帆　顾克繁

【摘要】 目的：总结经眉弓微骨窗入路显微手术切除鞍区肿瘤的经验。方法：对本院46例鞍区肿瘤患者采用经眉弓微骨窗入路显微手术切除肿瘤组织。结果：切口平均长度（6.22±1.24）cm，骨窗平均面积（8.51±1.80）cm2，开关颅平均时间（25.36±6.23）min，平均住院日（22.35±2.77）d，术后良好率86.96%，肿瘤全切率78.26%，术后并发症发生率10.87%。结论：经眉弓微骨窗入路显微手术切除鞍区肿瘤医源性损伤小、手术后反应轻、术后并发症少、手术效果好、保护患者的容貌等优点，值得临床推广应用，但对肿瘤组织巨大、质地较硬、与周围相关结构粘连紧密、血供丰富者，较难达到最佳手术效果。

【关键词】 经眉弓微骨窗入路； 鞍区肿瘤； 显微手术

46 Cases with Saddle Area Tumor of Microsurgical Removal by Eyebrow Microbone Window Approach/WEI Yao-gang，ZHANG Yong-fu，ZHOU Yi-fan，et al.//Medical Innovation of China，2017，14（26）：126-129

【Abstract】 Objective：To summarize the experience in microsurgical removal of the saddle area tumors by eyebrow microbone window approach.Method：A total of 46 patients saddle area tumors were cut off by eyebrow microbone window approach in our hospital.Result：The average length of the incision was （6.22±1.24）cm，the average area of bone window was （8.51±1.80）cm2，the average time of switch cranial was （25.36±6.23）min，the average length of stay was （22.35±2.77）d，the postoperative good rate was 86.96%，the total resection rate was 78.26%，and the rate of postoperative complications was 10.87%.Conclusion：The microsurgery via approach of eyebrow micro bone window is less atrogenic injury，lighter reaction after the operation，less postoperative complications，better operation effect and the patient's appearance protection，more worthy of clinical application，but the tumors that are huge，hard，closely sticky to the surroundings and rich blood supply are more difficult to achieve the best effect of surgery.

【Key words】 Eyebrow microbone window approach； Saddle area tumors； Microsurgery

First-authors address：Baiyin Second Peoples Hospital，Baiyin 730900，China

doi：10.3969/j.issn.1674-4985.2017.26.033

微骨窗入路顯微手术是近年来发展起来的一种微侵袭神经外科手术技术，已有国内外文献报道将该技术成功应用于颅内前循环动脉瘤和前颅底肿瘤的手术[1]。根据微创神经外科技术理念，本院自2007年1月-2016年10月采用眉弓微骨窗入路显微手术切除鞍区肿瘤46例，取得了良好的疗效，现报道如下。

1 资料与方法

1.1 一般资料 选取2007年1月-2016年10月本院采用眉弓微骨窗入路显微手术切除鞍区肿瘤患者46例，男25例，女21例；年龄23～71岁，平均（40.7±13.97）岁；垂体瘤23例，脑膜瘤17例，颅咽管瘤6例；病程19 d～4年；视力减退41例，偏盲37例，内分泌功能紊乱28例，头痛29例；肿瘤直径最大4.9 cm。诊断标准：术前均行MRI平扫和增强检查，确定肿瘤位置、大小、生长方向及血供情况；切除的肿瘤均经病理检查确诊。纳入标准：选择鞍结节和鞍膈脑膜瘤、向鞍上和鞍旁生长的垂体腺瘤、颅咽管瘤，肿瘤直径小于5 cm，手术入路无开颅手术病史。……