本文選題：頸椎椎體病變 + 內(nèi)鏡�。� 參考：《山東大學(xué)》2017年博士論文

【摘要】：研究背景臨床上頸椎椎體腫瘤比較少見,多發(fā)病隱匿,而且早期癥狀沒有特異性,故患者早期無明顯臨床癥狀,常被誤認(rèn)為頸椎病而延誤到出現(xiàn)脊髓壓迫癥狀時才來就診。Levine等報(bào)道一組9例頸椎腫瘤中,95%的患者有局限性疼痛,37%的頸椎良性腫瘤伴有根性痛�；颊咧�29%出現(xiàn)斜頸,14%出現(xiàn)感覺障礙,7%出現(xiàn)局限性運(yùn)動障礙。目前國內(nèi)外認(rèn)為手術(shù)是頸椎椎體腫瘤最重要、最有效的治療方法。傳統(tǒng)的頸椎椎體腫瘤手術(shù)方式主要有三種:前路手術(shù)、后路手術(shù)及前后聯(lián)合手術(shù),其存在手術(shù)徑路遠(yuǎn)、創(chuàng)傷大、有損傷頸部重要血管神經(jīng)引發(fā)嚴(yán)重并發(fā)癥可能,尤其是兒童頸椎惡性腫瘤手術(shù)難度大、易復(fù)發(fā),預(yù)后差,如何安全有效地暴露并切除頸椎椎體病變是臨床醫(yī)師正在探討中的課題,近年來以安全、可靠且創(chuàng)傷小的微創(chuàng)方法治療頸椎椎體病變逐漸應(yīng)用于臨床。隨著鼻內(nèi)鏡解剖、內(nèi)鏡技術(shù)和顱底外科學(xué)的發(fā)展,進(jìn)一步擴(kuò)大了鼻內(nèi)鏡外科手術(shù)的治療范圍。目前國內(nèi)外有關(guān)鼻內(nèi)鏡下口內(nèi)徑路對頸椎椎體腫瘤施行手術(shù)切除尚未有文獻(xiàn)報(bào)道。受學(xué)者們切除脊索瘤和齒狀突病變的啟發(fā),我們對20例新鮮尸頭標(biāo)本,進(jìn)行寰樞椎CT測量,獲得詳細(xì)的解剖學(xué)數(shù)據(jù),對10例新鮮灌注尸頭標(biāo)本,采用內(nèi)鏡下口內(nèi)徑路對頸椎椎體及相關(guān)區(qū)域行模擬手術(shù)并解剖學(xué)觀測。臨床上采用內(nèi)鏡下經(jīng)口徑路對8例頸椎椎體良性病變施行手術(shù)切除,主要論述了頸椎椎體良性病變內(nèi)鏡下口內(nèi)徑路切除術(shù)的手術(shù)特點(diǎn)、術(shù)中操作技巧以及術(shù)中、術(shù)后并發(fā)癥的預(yù)防等,探索頸椎椎體良性病變內(nèi)鏡下口內(nèi)徑路手術(shù)切除的可行性。目的探索頸椎椎體良性病變內(nèi)鏡下口內(nèi)徑路手術(shù)切除的可行性及臨床驗(yàn)證。資料和方法對20例新鮮尸頭標(biāo)本,進(jìn)行寰樞椎CT測量,獲得詳細(xì)的解剖學(xué)數(shù)據(jù),包括寰椎前弓長度、寰椎前結(jié)節(jié)厚度、寰椎側(cè)塊橫徑、寰椎側(cè)塊矢狀徑、寰樞椎兩側(cè)橫突孔內(nèi)側(cè)間距、寰樞椎兩側(cè)橫突孔外側(cè)間距等;對10例新鮮灌注尸頭標(biāo)本,采用內(nèi)鏡下口內(nèi)徑路對頸椎椎體及相關(guān)區(qū)域行模擬手術(shù)并解剖學(xué)觀測,以期為臨床提供較為詳實(shí)的解剖學(xué)資料。2013年10月-2015年10月,在深圳市第二人民醫(yī)院耳鼻咽喉科住院部,我們采用鼻內(nèi)鏡系統(tǒng)、經(jīng)口內(nèi)徑路切除8例頸椎椎體良性病變,男5例、女3例;年齡5歲-42歲,平均20歲;臨床表現(xiàn)為頸痛6例,頭痛2例,頭部不穩(wěn)感2例,頸部活動受限2例,頸部活動不適1例。嗜酸性肉芽腫7例、脂肪瘤1例。所有患者均在手術(shù)前、后行頸椎電子計(jì)算機(jī)斷層掃描(Computed tomography,CT)加增強(qiáng)軸位、冠狀位和矢狀位檢查,頸椎磁共振成像(Magnetic resonance imaging,MRI)檢查,以確定病變位置、范圍及與周圍結(jié)構(gòu)的關(guān)系。8例患者中5例侵犯寰樞椎椎體,3例侵犯第三頸椎椎體,均未侵及硬脊膜和脊髓。5例患者術(shù)前行三維(Three dimensional,3D)重建并3D打印模型,為術(shù)前治療方案設(shè)計(jì)及與患者家屬溝通提供了幫助。所有患者術(shù)前均已簽署手術(shù)知情同意書。結(jié)果新鮮尸頭寰樞椎CT測量值:寰椎前弓長度(19.6±2.6)mm,寰椎前結(jié)節(jié)厚度(8.1 ±0.7)mm,寰椎側(cè)塊橫徑(左)(12.8±2.6)MmMm,寰椎側(cè)塊橫徑(右)(12.8±1.9)mm,寰椎側(cè)塊矢狀徑(左)(14.9±2.4)mm,寰椎側(cè)塊矢狀徑(右)(15.2 ±1.6)mm,寰椎兩側(cè)橫突孔內(nèi)側(cè)間距(47.1±1.5)mm,寰椎兩側(cè)橫突孔外側(cè)間距(60.6± 1.6)mm,樞椎兩側(cè)橫突孔內(nèi)側(cè)間距(29.1 ±1.5)mm,樞椎兩側(cè)橫突孔外側(cè)間距(44.2士 1.8)mm。灌注尸頭標(biāo)本模擬手術(shù)結(jié)果:①內(nèi)鏡下口徑路可顯露寰樞椎腹側(cè),包括:寰椎、樞椎椎體,寰椎前弓、側(cè)塊,齒突及兩側(cè)椎動脈;②上方常規(guī)可顯露至寰椎前弓上緣或斜坡下部,下方可顯露至C2/3椎間盤或C3椎體上部,兩側(cè)安全邊界可界定:寰椎層面為寰樞側(cè)塊關(guān)節(jié)外緣,樞椎層面為樞椎體外緣�？蓾M足內(nèi)鏡口內(nèi)徑路手術(shù)需要。8例臨床患者病變均一次徹底切除,未見明顯并發(fā)癥發(fā)生;術(shù)后8小時經(jīng)口進(jìn)食;手術(shù)當(dāng)天全麻清醒后至術(shù)后第3天采用NRS評分法評估疼痛程度,平均2.25分;術(shù)后5天拆線并出院,平均住院時間6.5天;平均住院費(fèi)用8225元。隨訪3-12個月。8例患者均于術(shù)后3月行頸椎CT檢查,腫物均被完整切除,無復(fù)發(fā)。結(jié)論內(nèi)鏡口內(nèi)徑路頸椎椎體良性病變切除術(shù)對頸部椎體病變暴露清楚,此徑路具有徑路短、技術(shù)簡單、療效可靠、并發(fā)癥少、手術(shù)時間短、術(shù)后恢復(fù)快等優(yōu)點(diǎn),值得推廣。
[Abstract]:Background clinical cervical vertebra tumor is rare, frequently occult, and the early symptoms are not specific, so the patients have no obvious clinical symptoms in the early stage, and are often mistaken for cervical spondylosis to be delayed to the symptoms of spinal cord compression to report.Levine and other 9 cervical tumors, 95% of the patients have localized pain, and 37% of the cervical spine. Benign tumors are associated with root pain. 29% of the patients have torticollis, 14% have sensory disorders, and 7% have localized dyskinesia. At present, surgery is considered the most important and most effective method for cervical vertebra tumor. There are three methods of the traditional cervical vertebra tumor operation: anterior, posterior and combined surgery. The surgical path is far, the trauma is large and the serious complications of the important cervical vessels and nerves may be damaged. Especially, the operation of the cervical malignant tumor in children is difficult, easy to recur, and the prognosis is poor. How to expose and Excise cervical vertebra vertebral lesions safely and effectively is a subject being discussed by the clinicians. In recent years, the minimally invasive and safe side is safe, reliable and minimally invasive. The treatment of cervical vertebra vertebral lesions is gradually applied to clinical. With the development of endoscopic anatomy, endoscopic technique and skull base surgery, the scope of treatment for endoscopic surgery has been further expanded. With the elicitation of odontoid process, 20 cases of fresh cadaver head specimens were measured by CT, and detailed anatomical data were obtained. 10 cases of fresh perfusion head specimens were used to simulate the cervical vertebra and related areas by endoscopy. On the bed, 8 cases of cervical vertebra were treated by endoscopy. Surgical resection of sexual lesions was performed. The characteristics of endoscopic surgical resection of the cervical vertebra benign lesions, operation skills and prevention of postoperative complications were discussed. The feasibility of endoscopic surgical resection under endoscopy for cervical vertebral benign lesions was explored. The feasibility and clinical validation of surgical resection of the path. Data and methods were used to measure the atlantoaxial CT and obtain detailed anatomical data, including the length of the anterior arch of the atlas, the thickness of the anterior atlas, the lateral diameter of the atlas, the sagittal diameter of the atlas lateral mass, the inner space of the lateral transverse foramen of the atlantoaxial, and the lateral lateral transverse foramen of the atlantoaxial. In order to provide more detailed anatomical data of the cervical vertebra and related areas, 10 cases of fresh perfused cadaver head specimens were used to provide more detailed anatomical data of the cervical vertebra and related areas by endoscopy in order to provide more detailed anatomical data in the hospital department of the Department of Otolaryngology, Shenzhen No.2 People's Hospital, in October,.2013, October. We used the nasal endoscopy system. 8 cases of benign cervical vertebral lesions, 5 male and 3 female, aged 5 years -42 years old, with an average of 20 years of age, 6 cases of cervical pain, 2 headache, 2 head instability, 2 neck movement, 1 cervical motion discomfort, 7 eosinophilic granuloma and 1 cases of lipoma. All the patients were scanned by CT scan before operation. (Computed tomography, CT) plus axial, coronal and sagittal examination, cervical magnetic resonance imaging (Magnetic resonance imaging, MRI) examination to determine the location, range and relation to the surrounding structure in 5 cases of.8 patients who had infringed the atlantoaxial vertebral body and 3 cases of the third cervical vertebrae, both of which were not invaded by the spinal cord and spinal cord before operation. The Three dimensional (3D) reconstruction and 3D print model were used to provide help for the preoperative treatment scheme design and communication with the patient's family. All patients had signed the operation informed consent before operation. Results fresh cadaver head atlantoaxial CT measurements: the anterior atlas arch length (19.6 + 2.6) mm, the thickness of the anterior atlas (8.1 + 0.7) mm, and the lateral mass of the atlas ( Left) (12.8 + 2.6) MmMm, lateral mass of atlas (right) (12.8 + 1.9) mm, lateral mass of atlas (14.9 + 2.4) mm, sagittal diameter of atlas (15.2 + 1.6) mm, medial space distance (47.1 + 1.5) mm on the lateral transverse foramen of atlas (47.1 + 1.5) mm, lateral space between the lateral transverse foramen of atlas (29.1 + 12.8) mm, and lateral transverse process of the axis The surgical results of the cadaver head specimens of the lateral spaced space (44.2 st 1.8) mm. were simulated: (1) the endoscopic aperture route revealed the atlantoaxial ventral side, including the atlas, the axis of the axis, the anterior arch of the atlas, the lateral mass, the odontoid and the bilateral vertebral arteries; the above routine could be exposed to the upper or lower part of the anterior arch of the atlas or the lower part of the slope, and the lower part could be exposed to the upper part of the intervertebral disc or the C3 vertebral body, two The side safety boundary can be defined as the outer edge of the atlantoaxial side, the axis of the axis is the outer edge of the axis of the axis. It can satisfy the endoscopic surgery in.8 patients with a complete resection and no obvious complications. 8 hours after the operation, the operation is taken after the operation of the general anesthesia and the third day after the operation by the NRS score. The degree of pain was estimated at an average of 2.25 points, 5 days after operation and discharge, the average hospitalization time was 6.5 days, and the average hospitalization cost was 8225 yuan. All patients were followed up for 3-12 months and.8 patients were examined by cervical CT in March. All the tumors were completely removed and no recurrence was found. The path has the advantages of short path, simple technique, reliable curative effect, few complications, short operation time and quick postoperative recovery, and is worthy of promotion.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R687.3;R322.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 余勇;胡凡;張曉彪;葛俊琦;顧燁;謝濤;王學(xué)建;姜曉幸;蔣淳;;導(dǎo)航內(nèi)鏡下經(jīng)鼻齒狀突切除術(shù)治療顱底凹陷畸形[J];中國現(xiàn)代神經(jīng)疾病雜志;2012年04期

2 萬勇;梁堂釗;鄭召民;彭新生;陳立言;劉少喻;;兒童頸椎腫瘤外科治療[J];中山大學(xué)學(xué)報(bào)(醫(yī)學(xué)科學(xué)版);2009年S4期

3 胡建中;徐大啟;蔣衛(wèi)紅;王錫陽;張宏其;黃躍平;;枕頸融合聯(lián)合鼻內(nèi)鏡治療樞椎腫瘤[J];脊柱外科雜志;2007年05期

4 蔡維山;徐中和;郭東明;鐘波夫;劉恩志;;頸椎腫瘤的手術(shù)切除和穩(wěn)定性重建[J];廣東醫(yī)學(xué);2007年03期

5 張朝躍;苗驚雷;吳松;詹瑞森;;內(nèi)鏡下經(jīng)口咽入路寰樞椎手術(shù)的基礎(chǔ)與臨床研究[J];中國內(nèi)鏡雜志;2006年10期

6 林斌;郭林新;丁真奇;練克儉;郭延杰;郭志民;劉慶軍;;一期前后聯(lián)合入路上頸椎全切除術(shù)治療上頸椎腫瘤[J];臨床骨科雜志;2006年05期

7 尹慶水;權(quán)日;何帆;艾福志;麥小紅;;一期經(jīng)口前路腫瘤切除和前后路椎體重建治療樞椎骨巨細(xì)胞瘤[J];中國脊柱脊髓雜志;2006年01期

8 肖建如,賈連順;脊柱轉(zhuǎn)移性腫瘤的外科治療策略[J];中華骨科雜志;2003年01期

9 肖建如,賈連順,袁文,陳德玉,倪斌,趙定麟;頸椎原發(fā)性骨腫瘤的外科分期及其手術(shù)治療[J];中華骨科雜志;2001年11期

10 保建基,張志強(qiáng),宋來君,龍江;擴(kuò)大經(jīng)口入路切除顱底硬膜外腫瘤[J];中國神經(jīng)精神疾病雜志;2001年04期

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