脑胶质瘤患者显微手术治疗疗效及预后影响因素
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摘要
目的探讨脑胶质瘤患者显微手术治疗疗效和预后影响因素分析。方法选取2014年1月至2017年2月间宝鸡市人民医院收治的98例脑胶质瘤患者,按照治疗方法不同分为观察组和对照组,每组49例。观察组患者采用显微镜下手术切除治疗,对照组患者采用传统开颅术治疗,检测两组患者治疗前后精氨酸加压素(AVP)、催产素(OT)、β-内咖肽(β-EP)和肿瘤坏死因子-α(TNF-α)水平,评价两组患者认知功能、日常生活能力、术后并发症和生存率,分析影响患者生存率的因素。结果术后,两组患者AVP、OT、β-EP和TNF-α水平均下降,且对照组患者AVP、OT和β-EP水平均低于观察组,差异均有统计学意义(均P <0. 05)。治疗后,两组患者认知功能评分均高于治疗前,日常生活能力评分均低于治疗前,且观察组患者均优于对照组,差异均有统计学意义(均P <0. 05)。观察组患者偏瘫5例,感染3例,并发症发生率为16. 3%;对照组患者偏瘫6例,感染5例,并发症发生率为22. 4%,差异有统计学意义(P <0. 05)。观察组患者1年生存率为81. 6%(40例);预后影响单因素为年龄、肿瘤直径、病理分级、术后放化疗和术前卡式功能评分(均P <0. 05)。肿瘤直径和病理分级是影响显微镜下手术治疗患者预后的高危因素(均P <0. 05)。结论采用显微手术治疗脑胶质瘤患者,对患者神经肽水平影响较小,利于神经功能恢复,改善认知功能,提高日常生活能力。患者术后预后影响因素较多,建议采用放化疗治疗,以提高生存时间。
Objective To investigate the clinical efficacy of microsurgery treatment of glioma under microscope and analyze the prognostic factors. Methods A total of 98 patients with glioma who were admitted to People's Hospital of Baoji from January 2014 to February 2017 were grouped into an observation group and a control group according to treatment methods with 49 patients in each group respectively. The observation group underwent surgical resection under the microscope and the control group underwent traditional craniotomy. The levels of arginine vasopressin( AVP),oxytocin( OT),β-catenin( β-EP) and tumor necrosis factor-α( TNF-α) before and after treatment were detected in the two groups. The cognitive function,daily living,postoperative complications and survival of the two groups before and after treatment were detected. Results After surgery,the levels of AVP,OT,β-EP and TNF-α were significantly decreased in the two groups. However,the levels of AVP,OT and β-EP in the control group were significantly lower than those in the observation group( all P < 0. 05). Postoperatively,score of cognitive function was increased in both groups and the score of daily living was decreased in both groups with the observation group better than the control group( all P < 0. 05). Hemiplegia occurred in 5 patients and infections occurred in 3 patients in the observation group,and the incidence of complications was 16. 3%. For the control group,hemiplegia occurred in 6 patients,inflection occurred in 5 patients,and the incidence of complications was 22. 4%( all P < 0. 05). The 1-year survival was 81. 6%( 40 patients) for the control group.The single factors influencing the prognosis was age,tumor size,pathological grade,postoperative radiotherapy and chemotherapy,and preoperative KPS score( all P < 0. 05). Tumor size and pathological grade were high-risk factors for microscope prognosis( all P < 0. 05). Conclusion Surgical treatment of glioma patients under the microscope has little effect on the level of neuropeptides,which is beneficial to promote the recovery of neurological function,cognitive function and the ability of daily living. There are many factors influencing the prognosis of patients. It is recommended that radiotherapy and chemotherapy be given to improve their survival.
Objective To investigate the clinical efficacy of microsurgery treatment of glioma under microscope and analyze the prognostic factors. Methods A total of 98 patients with glioma who were admitted to People's Hospital of Baoji from January 2014 to February 2017 were grouped into an observation group and a control group according to treatment methods with 49 patients in each group respectively. The observation group underwent surgical resection under the microscope and the control group underwent traditional craniotomy. The levels of arginine vasopressin( AVP),oxytocin( OT),β-catenin( β-EP) and tumor necrosis factor-α( TNF-α) before and after treatment were detected in the two groups. The cognitive function,daily living,postoperative complications and survival of the two groups before and after treatment were detected. Results After surgery,the levels of AVP,OT,β-EP and TNF-α were significantly decreased in the two groups. However,the levels of AVP,OT and β-EP in the control group were significantly lower than those in the observation group( all P < 0. 05). Postoperatively,score of cognitive function was increased in both groups and the score of daily living was decreased in both groups with the observation group better than the control group( all P < 0. 05). Hemiplegia occurred in 5 patients and infections occurred in 3 patients in the observation group,and the incidence of complications was 16. 3%. For the control group,hemiplegia occurred in 6 patients,inflection occurred in 5 patients,and the incidence of complications was 22. 4%( all P < 0. 05). The 1-year survival was 81. 6%( 40 patients) for the control group.The single factors influencing the prognosis was age,tumor size,pathological grade,postoperative radiotherapy and chemotherapy,and preoperative KPS score( all P < 0. 05). Tumor size and pathological grade were high-risk factors for microscope prognosis( all P < 0. 05). Conclusion Surgical treatment of glioma patients under the microscope has little effect on the level of neuropeptides,which is beneficial to promote the recovery of neurological function,cognitive function and the ability of daily living. There are many factors influencing the prognosis of patients. It is recommended that radiotherapy and chemotherapy be given to improve their survival.
引文
[1]刘正清,罗琴,买买提艾力·吐尔逊,等.脑胶质瘤显微手术切除后植入缓释化疗药物联合增敏放疗的临床疗效[J].实用癌症杂志,2018,33:207-210.
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[7]胡韶山,丛大忞,李永哲,等.替莫唑胺联合光动力显微手术综合治疗功能区脑胶质瘤长期随访研究[J].中国激光医学杂志,2016,25:296.
[8]姚萌萌,方川,谢靖,等.放射治疗老年脑胶质瘤预后影响因素[J].中国老年学杂志,2016,36:1111-1113.
[9]曾剑平,刘青,林志雄,等.脑胶质瘤患者预后相关影响因素分析[J].临床神经外科杂志,2015,12:410-414.
[10]陈琴,向琰.高分级脑胶质瘤术后精确放疗患者的预后影响因素[J].现代肿瘤医学,2016,24:212-215.
[11]陈波,刘立军,雷艳青,等.显微手术与开放手术治疗脑胶质瘤的疗效对比观察[J].人民军医,2015,58:1301-1302.
[12]乔冠群,李英斌,马俊.影响脑胶质瘤预后的因素分析[J].中国临床研究,2015,28:1007-1009.
[13]李少琼,赵晓军,申宁宁,等.神经网络预后评价在脑胶质瘤患者术后生存质量分析中的应用[J].中国预防医学杂志,2015,16:175-179.
[14]房莉,章诗伟,李晶.脑胶质瘤患者预后影响因素分析[J].中国肿瘤,2014,23:1019-1023.
[15]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,2014,43:534-536.
[2]包志军,郭世文.脑胶质瘤患者预后影响因素分析[J].解放军预防医学杂志,2017,35:147-148.
[3]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,2017,15:53-55.
[4]张文燕,王翠英,赵宝帅,等.不同入路显微外科手术治疗脑胶质瘤的疗效观察[J].中国肿瘤临床与康复,2016,23:1471-1473.
[5]吴云龙,吕经柱.超声引导脑胶质瘤显微手术的应用价值和临床意义[J].中国肿瘤临床与康复,2016,23:1334-1336.
[6]王波,汪平,王宏,等.显微外科手术治疗脑胶质瘤的临床效果[J].实用癌症杂志,2016,31:1725-1727.
[7]胡韶山,丛大忞,李永哲,等.替莫唑胺联合光动力显微手术综合治疗功能区脑胶质瘤长期随访研究[J].中国激光医学杂志,2016,25:296.
[8]姚萌萌,方川,谢靖,等.放射治疗老年脑胶质瘤预后影响因素[J].中国老年学杂志,2016,36:1111-1113.
[9]曾剑平,刘青,林志雄,等.脑胶质瘤患者预后相关影响因素分析[J].临床神经外科杂志,2015,12:410-414.
[10]陈琴,向琰.高分级脑胶质瘤术后精确放疗患者的预后影响因素[J].现代肿瘤医学,2016,24:212-215.
[11]陈波,刘立军,雷艳青,等.显微手术与开放手术治疗脑胶质瘤的疗效对比观察[J].人民军医,2015,58:1301-1302.
[12]乔冠群,李英斌,马俊.影响脑胶质瘤预后的因素分析[J].中国临床研究,2015,28:1007-1009.
[13]李少琼,赵晓军,申宁宁,等.神经网络预后评价在脑胶质瘤患者术后生存质量分析中的应用[J].中国预防医学杂志,2015,16:175-179.
[14]房莉,章诗伟,李晶.脑胶质瘤患者预后影响因素分析[J].中国肿瘤,2014,23:1019-1023.
[15]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,2014,43:534-536.