显微手术治疗脑干海绵状血管瘤的临床效果和预后分析
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摘要
目的探讨显微手术治疗脑干海绵状血管瘤的临床效果和预后。方法回顾性分析2006年1月至2016年6月本院收治的14例行显微手术治疗的脑干海绵状血管瘤患者的临床资料,包括性别、年龄、临床表现、影像学检查、手术方法、手术全切率及术后1年的卡氏行为功能状态(Karnofsky performance status,KPS)评分。结果术中镜下和术后72小时内MRI和CT检查结果证实,肿瘤全切除13例,次全切1例;术后早期并发症:肢体轻瘫2例,面瘫3例,复视1例,吞咽困难2例,顽固性呃逆1例;KPS评分:术前为(74.36±6.14)分,术后72小时内为(83.57±7.73)分,术后随访1年时为(90.48±5.62)分,随访1年时KPS评分较术前和术后72小时均显著升高(P_均<0.05)。结论对有手术适应证的脑干海绵状血管瘤患者,将显微手术作为首选治疗方法可有效改善患者预后。
Objective To analyze the clinical effects and prognosis of microsurgery in the treatment of brainstem cavernous hemangioma. Method The clinical data of 14 patients with brainstem cavernous hemangioma treated by microsurgery in our hospital from January 2006 to June 2016 were retrospectively analyzed, including sex, age, clinical manifestations, imaging examinations, surgical methods, total resection rate and one-year postoperative Karnofsky performance status(KPS) score. Result The results of MRI and CT examination during operation and within 72 hours after operation showed that 13 cases were totally resected and 1 case was subtotally resected. The early complications include: 2 cases of limb paralysis, 3 cases of facial paralysis, 1 case of diplopia, 2 cases of dysphagia and 1 case of intractable hiccup. The KPS score was(74.36±6.14) before operation,(83.57±7.73) within 72 hours after operation, and(90.48±5.62) after 1-year follow-up. The KPS score after 1-year follow-up was significantly higher than that before operation and within 72 hours after operation(P_(all)< 0.05). Conclusion Microsurgery as the preferred treatment for patients with brainstem cavernous hemangioma with surgical indications can effectively improve the prognosis of patients.
Objective To analyze the clinical effects and prognosis of microsurgery in the treatment of brainstem cavernous hemangioma. Method The clinical data of 14 patients with brainstem cavernous hemangioma treated by microsurgery in our hospital from January 2006 to June 2016 were retrospectively analyzed, including sex, age, clinical manifestations, imaging examinations, surgical methods, total resection rate and one-year postoperative Karnofsky performance status(KPS) score. Result The results of MRI and CT examination during operation and within 72 hours after operation showed that 13 cases were totally resected and 1 case was subtotally resected. The early complications include: 2 cases of limb paralysis, 3 cases of facial paralysis, 1 case of diplopia, 2 cases of dysphagia and 1 case of intractable hiccup. The KPS score was(74.36±6.14) before operation,(83.57±7.73) within 72 hours after operation, and(90.48±5.62) after 1-year follow-up. The KPS score after 1-year follow-up was significantly higher than that before operation and within 72 hours after operation(P_(all)< 0.05). Conclusion Microsurgery as the preferred treatment for patients with brainstem cavernous hemangioma with surgical indications can effectively improve the prognosis of patients.
引文
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[16]陈锐聪,白小欣,张燕婷,等.脑干海绵状血管瘤的显微手术治疗[J].广东医学,2011,32(3):411.
[17]周德祥,詹升全,周东,等.脑干海绵状血管瘤显微手术治疗分析[J].中国脑血管病杂志,2016,13(8):431-435.
[18]薛毅辉,吴喜跃,陈剑舞,等.脑干海绵状血管瘤的显微外科手术治疗[C]//中华医学会神经外科学学术会议,2011:30-33.
[19]Brown AP,Thompson BG,Spetzler RF.The two-point method:evaluating brain stem lesions[J].BNI Q,1996,12:20-24.
[20]王真,王林,祝向东,等.脑干海绵状血管瘤及其手术治疗[J].浙江大学学报(医学版),2015,44(4):371-375.
[21]Ferroli P,Sinisi M,Franzini A,et al.Brainstem cavernomas:long-term results of microsurgical resection in 52 patients[J].Neurosurgery,2005,56(6):1203-1212.
[22]Wang CC,Liu A,Zhang JT,et al.Surgical management of brain-stem cavernous malformations:report of 137 cases[J].Surg Neurol,2003,59(6):444-454.
[2]陈立华,李文德,徐如祥.脑干海绵状血管瘤的特征性分析[J].中华神经创伤外科电子杂志,2015,1(6):41-45.
[3]张剑宁,程岗.脑干海绵状血管瘤治疗的研究进展[J].中华神经医学杂志,2013,12(3):322-324.
[4]陈见清,包映辉,崔华,等.显微外科治疗脑干海绵状血管瘤的研究进展[J].中国脑血管病杂志,2015,12(3):155-159.
[5]李防晔,陈晓雷,许百男.脑干海绵状血管瘤的手术治疗进展[J].中国神经精神疾病杂志,2013,39(4):254-256.
[6]宫崧峰,蒋太鹏,李维平,等.脑干海绵状血管瘤的显微手术治疗[J].中华显微外科杂志,2012,35(6):506-508.
[7]王健.MRI对脑干海绵状血管瘤的诊断价值及临床分析[J].中国当代医药,2013,20(24):115-116.
[8]李辉华,秦兴义,黄佳.颅内海绵状血管瘤30例的临床和影像学特点[J].中国临床实用医学,2008,2(7):32-33.
[9]Nahler MPG.Karnofsky performance status[M]//Dictionary of Pharmaceutical Medicine.Springer Vienna,2009:102.
[10]何占彪,王宏伟.脑内海绵状血管瘤的影像学诊断特点及治疗选择[J].中华神经外科疾病研究杂志,2016,15(4):378-380.
[11]王亮,张俊廷,吴震,等.脑干海绵状血管瘤的外科治疗进展[J].中国微侵袭神经外科杂志,2007,12(3):139-141.
[12]陈立华,徐如祥.脑干海绵状血管瘤:如何选择手术时机和适应证[J].临床神经外科杂志,2016,13(4):241-244.
[13]周良辅,毛颖,陈亮.海绵窦海绵状血管瘤的诊断和治疗[J].中华神经外科疾病研究杂志,2003,2(1):12-15.
[14]Giliberto G,Lanzino DJ,Diehn FE,et al.Brainstem cavernous malformations:anatomical,clinical,and surgical considerations[J].Neurosurg Focus,2010,29(3):E9.
[15]陈立华,徐如祥.脑干海绵状血管瘤:如何选择手术时机和适应证[J].临床神经外科杂志,2016,13(4):241-244.
[16]陈锐聪,白小欣,张燕婷,等.脑干海绵状血管瘤的显微手术治疗[J].广东医学,2011,32(3):411.
[17]周德祥,詹升全,周东,等.脑干海绵状血管瘤显微手术治疗分析[J].中国脑血管病杂志,2016,13(8):431-435.
[18]薛毅辉,吴喜跃,陈剑舞,等.脑干海绵状血管瘤的显微外科手术治疗[C]//中华医学会神经外科学学术会议,2011:30-33.
[19]Brown AP,Thompson BG,Spetzler RF.The two-point method:evaluating brain stem lesions[J].BNI Q,1996,12:20-24.
[20]王真,王林,祝向东,等.脑干海绵状血管瘤及其手术治疗[J].浙江大学学报(医学版),2015,44(4):371-375.
[21]Ferroli P,Sinisi M,Franzini A,et al.Brainstem cavernomas:long-term results of microsurgical resection in 52 patients[J].Neurosurgery,2005,56(6):1203-1212.
[22]Wang CC,Liu A,Zhang JT,et al.Surgical management of brain-stem cavernous malformations:report of 137 cases[J].Surg Neurol,2003,59(6):444-454.