显微镜下全切或次全切术对脑胶质瘤患者认知功能与神经肽水平的影响
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摘要
目的探讨显微镜下全切或次全切术对脑胶质瘤患者认知功能与神经肽水平的影响。方法以65例脑胶质瘤患者为研究对象,依据患者意愿将其分为观察组(n=31)与对照组(n=34)。对照组行常规开颅切除术,观察组则行显微镜下全切或次全切术。检测并比较2组患者手术前后认知功能及脑脊液中神经肽水平;统计2组手术时间、住院时间及术后并发症发生情况。结果与术前相比,术后6个月2组定向力、记忆力、注意力与计算力、回忆能力、语言能力等评分均显著升高(P<0.05或P<0.01),且观察组均显著高于对照组(P<0.05或P<0.01);与术前相比,术后6个月2组脑脊液中AVP、β-EP、OT水平均显著下降,NT、SS水平则显著升高(P<0.01),但观察组上述各指标水平均显著高于对照组(P<0.05或P<0.01);观察组手术时间与住院时间均显著短于对照组(P<0.01);2组间偏瘫、失语、感染等术后并发症发生率均无显著差异(P>0.05)。结论与常规开颅切除术相比,显微镜下全切或次全切术可更有效改善脑胶质瘤患者认知功能,恢复其脑脊液神经肽水平,更有利于患者预后,同时可以缩短患者手术及住院时间,值得临床推广。
Objective To explore the effects of total or subtotal resection under microscope on cognitive function and neuropeptide levels in patients with glioma. Methods 65 patients with glioma were treated in our hospital from May 2014 to July2017 wer selected,and they were divided into the observation group( n = 31) and the control group( n = 34) according to the patient's will,routine craniotomy was performed in the control group and total or subtotal resection under microscope was performed in the observation group. The cognitive function and the neuropeptide levels in cerebrospinal fluid before and after operation in the2 groups were compared. The time of operation and hospitalization and the incidence of postoperative complications in the 2 groups were analyzed. Results Compared with before operation,the scores of orientation,memory,attention and calculation,recall and language engery significantly increased in the 2 groups 6 months after operation( P < 0. 05 or P < 0. 01),and the observation group was significantly higher than the control group( P < 0. 05 or P < 0. 01); Compared with before operation,the levels of AVP,β-EP,OT in cerebrospinal fluid of the 2 groups significantly decreased,the NT,SS levels significantly increased 6 months after operation( P < 0. 01),however the levels of the above indexes in the observation group were significantly higher than those of the control group( P < 0. 05 or P < 0. 01); The time of operation and hospitalization in the observation group were significantly shorter than those of the control group( P < 0. 01); There was no significant difference in the incidence of postoperative complications such as hemiplegia,aphasia and infection between the 2 groups( P > 0. 05). Conclusion Compared with the routine craniotomy,total or subtotal resection under microscope has better effect on the cognitive function of the patients with glioma,and the recovery of the neuropeptides is better,so the prognosis is favorable and the clinical popularization is worthy.
Objective To explore the effects of total or subtotal resection under microscope on cognitive function and neuropeptide levels in patients with glioma. Methods 65 patients with glioma were treated in our hospital from May 2014 to July2017 wer selected,and they were divided into the observation group( n = 31) and the control group( n = 34) according to the patient's will,routine craniotomy was performed in the control group and total or subtotal resection under microscope was performed in the observation group. The cognitive function and the neuropeptide levels in cerebrospinal fluid before and after operation in the2 groups were compared. The time of operation and hospitalization and the incidence of postoperative complications in the 2 groups were analyzed. Results Compared with before operation,the scores of orientation,memory,attention and calculation,recall and language engery significantly increased in the 2 groups 6 months after operation( P < 0. 05 or P < 0. 01),and the observation group was significantly higher than the control group( P < 0. 05 or P < 0. 01); Compared with before operation,the levels of AVP,β-EP,OT in cerebrospinal fluid of the 2 groups significantly decreased,the NT,SS levels significantly increased 6 months after operation( P < 0. 01),however the levels of the above indexes in the observation group were significantly higher than those of the control group( P < 0. 05 or P < 0. 01); The time of operation and hospitalization in the observation group were significantly shorter than those of the control group( P < 0. 01); There was no significant difference in the incidence of postoperative complications such as hemiplegia,aphasia and infection between the 2 groups( P > 0. 05). Conclusion Compared with the routine craniotomy,total or subtotal resection under microscope has better effect on the cognitive function of the patients with glioma,and the recovery of the neuropeptides is better,so the prognosis is favorable and the clinical popularization is worthy.
引文
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[10]陈武,董辉,周志中.显微手术在脑胶质瘤中的应用及对脑脊液AVP、OT、β-EP、TNF-α水平的影响[J].癌症进展,2017,15(1):53-55.
[11]曹传宇,沈焱,高焕民,等.生长抑素、神经元特异性烯醇化酶与早期血管性痴呆的相关性[J].宁夏医学杂志,2015,37(6):487-489.
[12]魏红辉,魏旻俊.氨基酸受体拮抗剂对老年脑卒中后引发血管性痴呆患者学习记忆的影响[J].中国生化药物杂志,2016,36(11):173-175.
[13]吴克洪.脑胶质瘤患者显微手术后血流灌注及生活能力观察[J].深圳中西医结合杂志,2017,27(1):122-123.
[2]陈宝师,晋强,张忠,等.联合靶向治疗复发恶性脑胶质瘤的研究[J].中华神经医学杂志,2015,14(7):740-742.
[3]陈波,陈谦学.显微镜下全切或次全切术治疗脑胶质瘤的综合疗效及预后影响因素分析[J].疑难病杂志,2015,14(8):793-796.
[4]梁新.人脑胶质瘤组织中CD133的表达及其临床意义相关研究[D].河北医科大学,2014.
[5]瞿巍巍,王志云,黄培.硬膜外麻醉与静脉全身麻醉对老年骨科手术术后精神状态及认知功能的影响[J].中国医师杂志,2016,18(3):453-455.
[6]徐春华,刘越,肖利民,等.不同级别脑胶质瘤患者手术前后外周血T淋巴细胞免疫细胞水平变化及意义[J].重庆医学,2016,45(2):180-182.
[7]苏祖禄,陈浩皓,苏海,等.显微手术对87例脑胶质瘤患者认知、生活能力及血流灌注和神经肽水平的影响[J].重庆医学,2014,43(5):534-536.
[8]Song Z,Larkin TE,Malley MO,et al.Oxytocin(OT)and arginine-vasopressin(AVP)act on OT receptors and not AVP V1a receptors to enhance social recognition in adult Syrian hamsters(Mesocricetus auratus)[J].Horm Behav,2016,81(4):20-27.
[9]郑慧军,许红旗,胡国强,等.显微手术治疗脑胶质瘤的临床疗效观察[J].临床合理用药杂志,2017,7(1):99-100.
[10]陈武,董辉,周志中.显微手术在脑胶质瘤中的应用及对脑脊液AVP、OT、β-EP、TNF-α水平的影响[J].癌症进展,2017,15(1):53-55.
[11]曹传宇,沈焱,高焕民,等.生长抑素、神经元特异性烯醇化酶与早期血管性痴呆的相关性[J].宁夏医学杂志,2015,37(6):487-489.
[12]魏红辉,魏旻俊.氨基酸受体拮抗剂对老年脑卒中后引发血管性痴呆患者学习记忆的影响[J].中国生化药物杂志,2016,36(11):173-175.
[13]吴克洪.脑胶质瘤患者显微手术后血流灌注及生活能力观察[J].深圳中西医结合杂志,2017,27(1):122-123.