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目的:探讨颈静脉球体瘤手术进路及临床治疗方法。方法:18例患者术前均行神经耳科、影像学检查,根据肿瘤的大小及肿瘤的部位、扩展方向选择不同的手术入路,即耳内入路6例;耳后入路4例;侧颅底入路、颞下窝入路5例;经颞枕颈联合入路3例。肿瘤全切除14例,次全切除或大部分切除4例。结果:18例中,14例肿瘤全切除均满意,其中2例术后3年复发;4例部分切除术后残留瘤体放疗后1年复查无变化。随访2～6年,复查纯音测听:6例听力恢复平均24dB,12例听力与术前检查结果无明显差异。CT、MRI复查结果:12例患者的术腔为软组织填塞,未见肿瘤复发;2例术后3年出现患耳耳鸣,经CT和MRI检查见乳突腔有瘤组织复发,再次手术治疗后2年随访未见复发;4例次全切除和部分切除的患者,经术后放疗后2年复查CT、MRI,结果与放疗前瘤体的大小无明显差异。结论:手术治疗是颈静脉球体治疗的有效手段,根据肿瘤大小选择手术入路可以确保肿瘤的完整切除,术前肿瘤局部选择性血管栓塞可有效地减少术中出血和手术时间,对于残留组织可用放疗控制其发展。
Objective: To explore the surgical approach and clinical treatment of jugular bulb tumor. Methods: Eighteen patients underwent preoperative neurological otology and radiological examination. According to the tumor size and location of the tumor, Lateral skull base approach, infratemporal fossa approach in 5 cases; the temporal occipital and cervical approach in 3 cases. Tumor resection in 14 cases, subtotal resection or resection in 4 cases. Results: In 18 cases, 14 cases of tumor resection were satisfactory, of which 2 cases relapsed 3 years after surgery; 4 cases of partial resection residual tumor 1 year after radiotherapy no change in the review. Follow-up 2 to 6 years, review of pure tone audiometry: 6 cases of hearing recovery average 24dB, 12 cases of hearing and preoperative examination results no significant difference. The results of CT and MRI showed that the operation room of 12 patients was soft tissue stuffing without tumor recurrence. Two cases of ear tinnitus appeared in 3 years after operation. The tumor and tumor recurrence were found in mastoid cavity after CT and MRI examination. After reoperation There was no recurrence in 2 years follow-up. In 4 cases of subtotal and partial resection, CT and MRI were reviewed 2 years after radiotherapy. There was no significant difference between the two groups in tumor size before radiotherapy. Conclusion: Surgical treatment is an effective means for the treatment of jugular bulb. Choosing the surgical approach according to the tumor size can ensure the complete resection of the tumor. Partial preoperative selective embolization of the blood vessel can effectively reduce the intraoperative bleeding and the operation time, and can be used for residual tissue Radiotherapy controls its development.