脑膜瘤显微外科手术不同入路优势对比分析
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摘要
目的脑膜瘤为临床中的常见病,早期多无典型症状且手术难度较大,对患者健康和生命安全有严重影响。本研究旨在分析脑膜瘤的临床影像学特征,并探讨显微外科手术不同入路治疗的有效性和安全性,为临床治疗提供参考依据。方法选取2012-01-01-2015-09-01郑州市第一人民医院收治的124例脑膜瘤患者作为研究对象,均行显微外科手术治疗,根据不同入路分为经前纵裂入路组(前纵裂组,n=44)、经额下入路组(额下组,n=39)和经翼点入路组(翼点组,n=41)。比较3组手术切除效果、神经功能缺损、视力恢复效果和并发症发生率。计量资料多组间比较采用方差分析,计数资料比较采用χ~2检验及多独立样本Kruskal-Wallis检验。结果 3组手术切除效果比较差异无统计学意义,H=0.773,P=0.680。3组术后GCS评分高于术前,前纵裂组GCS评分为(14.57±0.37)分,高于额下组的(11.26±0.43)分和翼点组的(11.39±0.48)分,差异有统计学意义,F=17.384,P<0.001;前纵裂组视力恢复有效率为81.82%,与额下组的76.92%和翼点组的82.93%比较,差异无统计学意义,χ~2=0.523,P=0.770;前纵裂组并发症发生率为6.82%,与额下组的25.64%和翼点组的21.95%比较,差异无统计学意义,χ~2=5.763,P=0.056。结论 3种入路方式均可有效切除肿瘤,但前纵裂入路对患者损伤较小。
OBJECTIVE Meningioma is a common disease in the clinic.There are not typical symptoms in the early stage and the operation is difficult,which have serious influences on the health and life safety of patients.This study is aimed at analyzing clinical imaging features of meningioma,investigating the effectiveness and safety of microsurgery through different approaches for the disease,and providing reference for clinical treatment.METHODS Totally 124 patients with meningioma who were admitted to Zhengzhou first people's hospital during the period from January 1,2012 to September 1,2015 were enrolled as study objects.All patients underwent microsurgery.They were divided into anterior interhemispheric fissure approach group(anterior interhemispheric fissure group,n=44),subfrontal approach group(subfrontal group,n=39)and pterional approach group(pterional group,n=41)according to different approaches.The effect of surgical resection,neurological impairment,visual recovery effect and incidence of complications were compared among the three groups.Measurement data were compared by variance analysis.The enumeration data were compared by chisquare test and independent-samples Kruskal-Wallis test.RESULTS There was no significant difference in the effect of surgical resection among the three groups(H=0.773,P=0.680).The GCS scores of the three groups after operation were higher than those before operation.The GCS score in the anterior interhemispheric fissure group [(14.57±0.37)points]was higher than that in the subfrontal group[(11.26±0.43)points]and the pterional group[(11.39±0.48)points](F=17.384,P<0.001).There was no significant difference in visual recovery effect among anterior interhemispheric fissure group,subfrontal group and pterional group(81.82%,76.92%,82.93%)(χ~2=0.523,P=0.770).There was no significant difference in incidence of complication among anterior interhemispheric fissure group,subfrontal group and pterional group(6.82%,25.64%,21.95%)(χ~2=5.763,P=0.056).CONCLUSIONS All the three approaches methods can effectively resect the tumors.The injury is less by anterior interhemispheric fissure approach.
OBJECTIVE Meningioma is a common disease in the clinic.There are not typical symptoms in the early stage and the operation is difficult,which have serious influences on the health and life safety of patients.This study is aimed at analyzing clinical imaging features of meningioma,investigating the effectiveness and safety of microsurgery through different approaches for the disease,and providing reference for clinical treatment.METHODS Totally 124 patients with meningioma who were admitted to Zhengzhou first people's hospital during the period from January 1,2012 to September 1,2015 were enrolled as study objects.All patients underwent microsurgery.They were divided into anterior interhemispheric fissure approach group(anterior interhemispheric fissure group,n=44),subfrontal approach group(subfrontal group,n=39)and pterional approach group(pterional group,n=41)according to different approaches.The effect of surgical resection,neurological impairment,visual recovery effect and incidence of complications were compared among the three groups.Measurement data were compared by variance analysis.The enumeration data were compared by chisquare test and independent-samples Kruskal-Wallis test.RESULTS There was no significant difference in the effect of surgical resection among the three groups(H=0.773,P=0.680).The GCS scores of the three groups after operation were higher than those before operation.The GCS score in the anterior interhemispheric fissure group [(14.57±0.37)points]was higher than that in the subfrontal group[(11.26±0.43)points]and the pterional group[(11.39±0.48)points](F=17.384,P<0.001).There was no significant difference in visual recovery effect among anterior interhemispheric fissure group,subfrontal group and pterional group(81.82%,76.92%,82.93%)(χ~2=0.523,P=0.770).There was no significant difference in incidence of complication among anterior interhemispheric fissure group,subfrontal group and pterional group(6.82%,25.64%,21.95%)(χ~2=5.763,P=0.056).CONCLUSIONS All the three approaches methods can effectively resect the tumors.The injury is less by anterior interhemispheric fissure approach.
引文
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[10]刘江峰,姬西团,白凯,等.显微外科手术不同入路治疗脑膜瘤150例疗效观察[J].陕西医学杂志,2014,43(4):465-466.
[11]邹坤良,陈忠,蔡洪,等.显微外科手术不同入路治疗鞍结节脑膜瘤的临床分析[J].中国肿瘤临床与康复,2015,22(2):200-201.
[12]张治平,蒋宇钢,尹畅,等.鞍结节脑膜瘤的手术入路选择及显微手术切除[J].中华显微外科杂志,2006,29(3):235-237.
[13]任圣利.鞍结节脑膜瘤术后视力影响因素分析[J].临床军医杂志,2018,46(2):220,223.
[14]雷鸣,黄书岚.鞍结节脑膜瘤的显微手术治疗[J].中国临床神经外科杂志,2015,20(4):201-204.
[15]秦汉,龚杰,张戈,等.鞍结节脑膜瘤的影像学特征及翼点锁孔手术治疗[J].中国临床神经外科杂志,2014,19(11):641-644.
[2]李凯,李立新,黄保胜,等.鞍结节脑膜瘤32例显微手术治疗体会[J].江苏医药,2015,41(16):1910-1913.
[3] Schroeder HW.Indications and limitations of the endoscopic endonasal approach for anterior cranial base meningiomas[J].World Neurosurgery,2014,82(6):S81-85.
[4] Louis DN,Perry A,Reifenberger G,et al.The 2016 World Health Organization Classification of Tumors of the Central Nervous System:A summary[J].Acta Neuropathol,2016,131(6):803-820.
[5]何思锦,白小欣.去骨瓣血肿清除术结合颅内压监测对基底节区高血压脑出血患者神经功能和血脑屏障指数的影响[J].现代中西医结合杂志,2017,26(19):2104-2107.
[6]谭可,李锦平,宋英伦,等.鞍结节脑膜瘤显微手术治疗的探讨[J].中国医药导刊,2015,17(7):680-683.
[7]李太平.不同手术入路治疗鞍结节脑膜瘤67例临床效果[J].解放军医药杂志,2015,27(2):63-65.
[8]王雷,简志宏,葛培林,等.翼点入路切除鞍结节脑膜瘤[J].临床外科杂志,2015,23(6):415-416.
[9] Tayebi Meybodi A,Lawton MT,Tabani H,et al.Tonsillobiventral fissure approach to the lateral recess of the fourth ventricle[J].J Neurosurg,2017,127(4):768-774.
[10]刘江峰,姬西团,白凯,等.显微外科手术不同入路治疗脑膜瘤150例疗效观察[J].陕西医学杂志,2014,43(4):465-466.
[11]邹坤良,陈忠,蔡洪,等.显微外科手术不同入路治疗鞍结节脑膜瘤的临床分析[J].中国肿瘤临床与康复,2015,22(2):200-201.
[12]张治平,蒋宇钢,尹畅,等.鞍结节脑膜瘤的手术入路选择及显微手术切除[J].中华显微外科杂志,2006,29(3):235-237.
[13]任圣利.鞍结节脑膜瘤术后视力影响因素分析[J].临床军医杂志,2018,46(2):220,223.
[14]雷鸣,黄书岚.鞍结节脑膜瘤的显微手术治疗[J].中国临床神经外科杂志,2015,20(4):201-204.
[15]秦汉,龚杰,张戈,等.鞍结节脑膜瘤的影像学特征及翼点锁孔手术治疗[J].中国临床神经外科杂志,2014,19(11):641-644.