听神经瘤术后面神经功能损伤的相关因素分析

发布时间：2018-03-12 11:15

  本文选题：听神经瘤　切入点：面神经功能　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景和目的:听神经瘤术后患者在面神经解剖保留的情况下也常常会出现周围性面瘫等面神经损伤症状,本研究旨在探究听神经瘤术后面神经功能性损伤的相关因素,从而为术中保护面神经功能、改善患者预后提供一定的理论依据。方法:回顾性分析浙江大学医学院附属第二医院神经外科在2014年1月1日至2014年12月31日期间收治并符合研究条件的73例听神经瘤患者的临床资料,术后6月采用House-Brackmann面神经功能分级对患者面神经功能进行分级。分别对患者性别、年龄、肿瘤大小、术中面神经监测情况、肿瘤切除率及手术时长进行单因素分析,再对其中有统计学意义的因素进行Logistic回归分析。结果:本文共纳入73例患者,男性27例,女性46例,男女比1:1.7;年龄最小24岁,最大76岁,平均年龄50岁;肿瘤最大直径为1.2-6.3cm,平均3.1cm,肿瘤直径≤3cm的有40例,3cm的有33例;术中行面神经监测的有53例,未行的有20例;肿瘤全切51例,部分切除22例;手术时长4小时的有42例,≥4小时的有31例。术后6月面神经功能较好者(Ⅰ-Ⅲ级)52例,占71.2%,功能较差者(Ⅳ-Ⅵ级)21例,占28.8%。单因素分析显示听神经瘤术后患者面神经功能与肿瘤大小(χ2 = 11.427,P = 0.001)、是否行面神经监测(χ2 = 6.061,P = 0.014)、肿瘤切除率(χ2 = 6.928,P = 0.008)以及手术时间(χ2 = 4.560,P = 0.033)有关。多因素Logistic回归结果显示肿瘤大小(P = 0.043)和是否行面神经监测(P =0.030)是影响术后面神经功能的独立相关因素。结论:肿瘤大小及术中是否行面神经功能监测是影响术后面神经功能的独立相关因素。肿瘤越大,手术切除后面神经功能损伤也越大,而术中面神经监测可以对面神经功能起到保护作用。
[Abstract]:Background and objective: facial nerve injury symptoms such as peripheral facial paralysis often occur in patients with facial nerve preservation after acoustic neuroma surgery. The purpose of this study was to explore the related factors of facial nerve functional injury after acoustic neuroma surgery. In order to protect facial nerve function during operation, Methods: a retrospective analysis of 73 cases of hearing in the second affiliated Hospital of Zhejiang University Medical College from January 1st 2014 to December 31st 2014 was conducted. Clinical data of patients with neuroma, In June, the facial nerve function of the patients was graded by House-Brackmann 's facial nerve function grading. The patients' sex, age, tumor size, intraoperative facial nerve monitoring, tumor resection rate and length of operation were analyzed by single factor analysis. Results: there were 73 patients, male 27, female 46, the ratio of male to female was 1: 1.7, the age was 24 years old, the maximum was 76 years old, the average age was 50 years old. The maximum diameter of the tumor was 1.2-6.3 cm (mean 3.1 cm). There were 33 cases with tumor diameter 鈮，

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