侧脑室三角区脑膜瘤术后发生孤立颞角综合征的相关危险因素分析

发布时间：2018-04-21 10:43

本文选题：孤立颞角综合征 + 局限性脑积水　；参考：《首都医科大学》2017年硕士论文

【摘要】：目的:孤立颞角综合征属于一种特殊类型的局限性脑积水,可发生在侧脑室三角区脑膜瘤切除术后,属于一种严重的并发症,可危及患者生命。然而,导致这种并发症形成和发生的危险因素在文献中较少被提及。因此,探索并分析导致侧脑室三角区脑膜瘤切除术后发生孤立颞角综合征的危险因素,对于预防和减少这种严重的并发症具有重要意义。方法:对北京天坛医院从2011年11月到2015年3月收治的121例侧脑室三角区脑膜瘤手术的病例进行回顾性分析,将患者的一般情况、临床表现、影像学资料、手术过程、术后并发症及术后的随访情况进行统计学分析。结果:该组病例的中位随访时间为24.1个月,总共有23例(19.8%)三角区脑膜瘤的患者术后出现孤立颞角综合征。单因素分析显示较年轻患者(40岁)、病史时间较长(3个月)、术后出现脑膜炎及术后脑室外引流时间较长者出现孤立颞角的风险明显增加。进一步行多因素Logistics回归分析发现,术前临床病史3个月(OR=4.8,P=0.008)、术后出现神经功能缺失(OR=4.2,P=0.014)、术后脑室外引流管留置时间3天(OR=4.8,P=0.012)及术后出现脑膜炎(OR=9.9,P=0.001)是导致术后发生孤立颞角综合征的独立的危险因素。结论:三角区脑膜瘤术后孤立颞角综合征的发生率较高,术区周围脑室壁的完整性遭到破坏、损伤可导致孤立颞角综合征的发生。此外,术后对脑室外引流管和脑膜炎的管理非常重要。术后是否留置脑室外引流管应根据每个患者的具体情况进行个体化决定,患者术后若无特殊情况,应尽早拔除脑室外引流管,防止脑脊液过度引流,从而防止脑室壁发生过度塌陷,引起互相粘连,导致孤立颞角综合征的发生。
[Abstract]:Objective: isolated temporal horn syndrome belongs to a special type of localized hydrocephalus. It can occur after the resection of meningioma in the lateral ventricle trigonometry. It is a serious complication and can endanger the life of the patients. However, the risk factors leading to the formation and occurrence of such complications are less mentioned in the literature. Therefore, it is of great significance to explore and analyze the risk factors leading to the occurrence of isolated temporal horn syndrome after resection of meningiomas in the trigonometric region of the lateral ventricle, which is of great significance in preventing and reducing this serious complication. Methods: from November 2011 to March 2015, 121 cases of meningioma in the trigonometric region of lateral ventricle were treated in Temple of Heaven Hospital in Beijing. The general situation, clinical manifestation, imaging data and surgical procedure were analyzed retrospectively. Postoperative complications and postoperative follow-up were statistically analyzed. Results: the median follow-up time was 24.1 months. In total, 23 patients with trigonometric meningioma developed solitary temporal horn syndrome. Univariate analysis showed that the younger patients were 40 years old and had a longer history (3 months). The risk of postoperative meningitis and postoperative ventricular drainage was significantly higher than that of elderly patients with isolated temporal horn. Further multivariate Logistics regression analysis showed that, The clinical history of preoperation was 4. 8% P0. 008, the nerve function loss was 4. 2% P0. 014, the 3 days after operation, the indwelling time of ventricular drainage tube was 4. 8% P0. 012) and the occurrence of meningitis was 9. 9% P0. 001) were the independent risk factors for the occurrence of isolated temporal horn syndrome after the operation. The clinical history was 4. 8% P0. 008, and the postoperative time of left ventricular drainage tube was 4. 8% P0. 012) and 9. 9% P0. 001 of meningitis. Conclusion: the incidence of isolated temporal horn syndrome after operation of trigonometric meningioma is high. The integrity of the ventricular wall around the operation area is damaged and the injury can lead to the occurrence of isolated temporal horn syndrome. In addition, postoperative management of ventricular drainage tube and meningitis is very important. The individual decision should be made according to the specific conditions of each patient. If there is no special situation, the patient should remove the ventricular drainage tube as soon as possible to prevent the excessive drainage of cerebrospinal fluid. Thus preventing excessive collapse of the ventricular wall, resulting in adhesion, leading to the occurrence of isolated temporal horn syndrome.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.45

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