脑膜瘤术后脑水肿加重的相关因素分析
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摘要
目的探讨影响脑膜瘤术后脑水肿加重的危险因素。方法回顾性分析2016年1月1日至2018年2月5日在我院神经外科手术治疗的187例脑膜瘤患者的临床资料及术后脑水肿加重的发生情况,统计影响脑膜瘤术后脑水肿加重的相关危险因素。结果术前无瘤周水肿的脑膜瘤患者术后发生水肿加重的发生率(26.23%)高于术前存在瘤周水肿患者(13.8%),可能由于病例数不足等原因,差异并无统计学意义,但是将所有相关因素一起进行多因素分析发现术前有无瘤周水肿是脑膜瘤术后脑水肿加重的影响因素(P=0.005)。通过单因素分析发现,肿瘤部位是脑膜瘤术后脑水肿加重的危险因素;通过多因素分析及多个率的多重比较发现,窦镰旁部位是脑膜瘤术后脑水肿加重的独立危险因素。结论脑膜瘤术前存在瘤周水肿可能是其术后脑水肿加重的一个保护性因素。位于窦镰旁部位的脑膜瘤,术后脑水肿加重的发生率明显高于其他部位,因此对位于窦镰旁部位的脑膜瘤,临床上应予以高度重视,术中注意引流静脉的保护,加强围手术期管理,及时予以激素和后续的脱水治疗,以改善患者的预后。
Objective To investigate the risk factors of aggravated cerebral edema after meningioma surgery.Methods Respectively analyze the clinical data of 187 patients received neurosurgery operation in our hospital from January 1,2016 to February 5,2018 and their postoperative aggravated cerebral edema,the related risk factors for brain edema after meningioma surgery was summarized.Results The incidence of aggravated cerebral edema in patients without preoperative edema(26.23%) was higher than that in patients with preoperative edema(13.8%),the difference was not statistically significant,probably due to the small number of cases or other related factors.Multivariate analysis of all related factors found that preoperative edema was the influencing factor for the increase of brain edema after meningioma surgery(P = 0.005).It was found by single factor analysis that tumor site was a risk factor for the aggravation of cerebral edema after meningioma surgery.Multivariate analysis and multiple rate comparisons revealed that the sagittal sinus falx area was an independent risk factor for the aggravation of cerebral edema after meningioma surgery.Conclusion The presence of peritumoral edema before surgery may be a protective factor for the postoperative brain edema.The incidence of postoperative cerebral edema was significantly higher in meningiomas located near the sagittal sinus falx than that of other sites.Therefore,meningiomas located near the sagittal sinus falx should be attached great importance.During the operation,the venous drainage should be protected,the perioperative management should be strengthened,and hormone and subsequent dehydration should be given timely to improve the prognosis of patients.
Objective To investigate the risk factors of aggravated cerebral edema after meningioma surgery.Methods Respectively analyze the clinical data of 187 patients received neurosurgery operation in our hospital from January 1,2016 to February 5,2018 and their postoperative aggravated cerebral edema,the related risk factors for brain edema after meningioma surgery was summarized.Results The incidence of aggravated cerebral edema in patients without preoperative edema(26.23%) was higher than that in patients with preoperative edema(13.8%),the difference was not statistically significant,probably due to the small number of cases or other related factors.Multivariate analysis of all related factors found that preoperative edema was the influencing factor for the increase of brain edema after meningioma surgery(P = 0.005).It was found by single factor analysis that tumor site was a risk factor for the aggravation of cerebral edema after meningioma surgery.Multivariate analysis and multiple rate comparisons revealed that the sagittal sinus falx area was an independent risk factor for the aggravation of cerebral edema after meningioma surgery.Conclusion The presence of peritumoral edema before surgery may be a protective factor for the postoperative brain edema.The incidence of postoperative cerebral edema was significantly higher in meningiomas located near the sagittal sinus falx than that of other sites.Therefore,meningiomas located near the sagittal sinus falx should be attached great importance.During the operation,the venous drainage should be protected,the perioperative management should be strengthened,and hormone and subsequent dehydration should be given timely to improve the prognosis of patients.
引文
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[21]杨秋雄,林成达,蔡奋忠,等.脑膜瘤组织中Ki-67蛋白的表达及与患者临床病理特征的关系[J].中国临床研究,2018,31(3):362-364.doi:10.13429/j.cnki.cjcr.2018.03.018.
[22]袁军辉,石东付,吕岩松,等.脑膜瘤瘤周水肿与肿瘤部位、病理分级和Ki-67的相关性研究[J].中国微侵袭神经外科杂志,2017,22(12):557-561.doi:10.11850/j.issn.1009-122X.2017.12.009.
[23]Chen WC,Magill ST,Englot DJ,et al.Factors associated with pre-and postoperative seizures in 1033 patients undergoing supratentorial meningioma resection[J].Neurosurgery,2017,81(2):297-306.doi:10.1093/neuros/nyx001.
[24]Englot DJ,Magill ST,Han SJ,et al.Seizures in supratentorial meningioma:a systematic review and meta-analysis[J].J Neurosurg,2016,124(6):1552-1561.doi:10.3171/2015.4.JNS142742.
[25]中华医学会神经外科学分会.颅内肿瘤周围水肿药物治疗专家共识(第1版)[J].中华医学杂志,2010,90(1):5-9.doi:10.3760/cma.j.issn.0376-2491.2010.01.002.
[2]Ostrom QT,Gittleman H,Liao P,et al.CBTRUS statistical report:primary brain and central nervous system tumors diagnosed in the United States in 2007-2011[J].Neuro-oncology,2014,16(Suppl 4):iv1-63.doi:10.1093/neuonc/nou223.
[3]Claus EB,Bondy ML,Schildkraut JM,et al.Epidemiology of intracranial meningioma[J].Neurosurgery,2005,57(6):1088-1095.doi:10.1227/01.NEU.0000188281.91351.B9.
[4]Hasseleid BF,Meling TR,Rnning P,et al.Surgery for convexity meningioma:Simpson Grade I resection as the goal:clinical article[J].JNeurosurg,2012,117(6):999-1006.doi:10.3171/2012.9.JNS12294.
[5]于洪泉,张宇,许冰,等.老年人上矢状窦旁脑膜瘤术后脑水肿及脑血管痉挛原因分析及治疗体会[J].中风与神经疾病,2011,28(9):813-814.doi:10.3969/j.issn.1003-2754.2007.01.028.
[6]Kinjo T,al-Mefty O.Grade zero removal of supratentorial convexity meningiomas[J].Neurosurgery,1993,33(3):394-399.doi:10.1097/00006123-199309000-00007.
[7]Katarzyna Stpień,Ostrowski RP,Matyja E.Hyperbaric oxygen as an adjunctive therapy in treatment of malignancies,including brain tumours[J].Medical Oncology,2016,33(9):101.doi:10.1007/s12032-016-0814-0.
[8]马付勇.高压氧辅助治疗脑膜瘤术后脑水肿的疗效观察[J].临床医药文献电子杂志,2016,3(32):6369-6370.doi:10.16281/j.cnki.jocml.2016.32.040.
[9]杨超,游彦莉,韩福刚.磁共振脑白质成像诊断脑膜瘤的临床价值探讨[J].实用医院临床杂志,2016,13(3):40-41.
[10]王玉玉,李毅,吴海涛,等.显微外科治疗矢状窦、镰旁脑膜瘤的效果分析[J].实用医学杂志,2013,29(11):1881-1882.
[11]党连锋,千超,肖三潮,等.大脑镰旁脑膜瘤显微手术治疗65例效果及预后影响因素分析[J].西南国防医药,2016,26(10):1138-1140.doi:10.3969/j.issn.1004-0188.2016.10.017.
[12]Arai S,Shimizu K,Yamochi T,et al.Preoperative embolization of meningiomas:differences in surgical operability and histopathologic changes between embosphere and N-butyl 2-cyanoacrylate[J].World Neurosurgery,2017,111:113-119.doi:10.1016/j.wneu.2017.12.003.
[13]唐田,古善智,李国文,等.巨型富血供脑膜瘤术前栓塞的临床应用[J].介入放射学杂志,2017,26(4):355-358.doi:10.3969/j.issn.1008-794X.2017.04.017.
[14]Li Z,Li H,Jiao Y,et al.A comparison of clinicopathological features and surgical outcomes between pediatric skull base and non-skull base meningiomas[J].Childs Nerv Syst,2017,33(4):595-600.doi:10.1007/s00381-016-3278-9.
[15]Perrini P,Russo P D,Benedetto N.Fatal cerebellar infarction after sacrifice of the superior petrosal vein during surgery for petrosal apex meningioma[J].J Clin Neurosci,2016,35:144-145.doi:10.1016/j.jocn.2016.10.027.
[16]何明杰,王恩任,张列,等.高压氧辅助治疗脑膜瘤患者术后脑水肿的临床疗效观察[J].实用医院临床杂志,2017,14(6):98-100.doi:10.3969/j.issn.1672-6170.2017.06.028.
[17]Klatzo I.Presidental address.Neuropathological aspects of brain edema[J].J Neuropathol Exp Neurol,1967,26(1):1-14.
[18]张煜辉,岳志健,王来兴,等.脑膜瘤瘤周水肿相关因素研究[J].中华神经外科疾病研究杂志,2008,7(2):141-144.doi:10.3969/j.issn.1671-2897.2008.02.012.
[19]Hua L,Luan S,Li H,et al.Angiomatous meningioma have a very benign outcome despite frequent peritumoral edema at onset[J].World Neurosurgery,2017,108:465-473.doi:10.1016/j.wneu.2017.08.096.
[20]Gawlitza M,Fiedler E,Schob S,et al.Peritumoral brain edema in meningiomas depends on aquaporin-4 expression and not on tumor grade,tumor volume,cell count,or Ki-67 labeling index[J].Mol Imaging Biol,2016,19(2):1-7.doi:10.1007/s11307-016-1000-7.
[21]杨秋雄,林成达,蔡奋忠,等.脑膜瘤组织中Ki-67蛋白的表达及与患者临床病理特征的关系[J].中国临床研究,2018,31(3):362-364.doi:10.13429/j.cnki.cjcr.2018.03.018.
[22]袁军辉,石东付,吕岩松,等.脑膜瘤瘤周水肿与肿瘤部位、病理分级和Ki-67的相关性研究[J].中国微侵袭神经外科杂志,2017,22(12):557-561.doi:10.11850/j.issn.1009-122X.2017.12.009.
[23]Chen WC,Magill ST,Englot DJ,et al.Factors associated with pre-and postoperative seizures in 1033 patients undergoing supratentorial meningioma resection[J].Neurosurgery,2017,81(2):297-306.doi:10.1093/neuros/nyx001.
[24]Englot DJ,Magill ST,Han SJ,et al.Seizures in supratentorial meningioma:a systematic review and meta-analysis[J].J Neurosurg,2016,124(6):1552-1561.doi:10.3171/2015.4.JNS142742.
[25]中华医学会神经外科学分会.颅内肿瘤周围水肿药物治疗专家共识(第1版)[J].中华医学杂志,2010,90(1):5-9.doi:10.3760/cma.j.issn.0376-2491.2010.01.002.