2384例颅内脑膜瘤流行病学和并发症研究

发布时间：2018-06-03 08:42

  本文选题：脑膜瘤 + 流行病学　； 参考：《郑州大学》2017年硕士论文

【摘要】：目的:总结并分析颅内脑膜瘤的流行病学特征,术后并发症特点及导致术后并发症的因素,为颅内脑膜瘤的临床研究和治疗提供帮助。方法:按照WHO 2016年中枢神经系统肿瘤分类标准纳入病例,回顾性分析2012年1月至2016年12月郑州大学第一附属医院神经外科收治的,病理诊断为颅内脑膜瘤的病例2384例,对患者的性别、年龄、地区分布、临床表现、肿瘤部位、肿瘤大小、手术切除程度、病理类型、术后并发症等流行病学特征进行描述,两组定性资料间比较采用χ2检验,应用多因素logistic回归分析导致术后并发症的相关因素。然后结合临床及相关文献,总结颅内脑膜瘤流行病学特点和治疗经验。结果:2384例颅内脑膜瘤患者男女之比为1:2.48,各年龄组女性病例数均高于男性。患者年龄最小7岁,最大88岁,平均52.9±12.2岁,发病高峰年龄组为50~59岁。河南省内患者地区分布最多的是豫南地区(26.1%)。肿瘤最小0.4cm,最大12.3cm,平均3.8±1.5cm。肿瘤起源位置最多的是大脑镰及矢状窦(25.3%)。最常见的临床表现是头痛头昏。以SimpsonⅠ级/SimpsonⅡ级切除为标准,切除率最高的肿瘤部位为幕上凸面(91.9%)。病理分级WHOⅠ级脑膜瘤1925例(80.7%),WHOⅡ级420例(17.6%),WHOⅢ级39例(1.6%)。术后最常见的神经系统并发症为颅内出血(9.1%)。患者年龄≥60岁,术前KPS≤70分,肿瘤长径≥7cm、肿瘤位于鞍区或其他罕见部位(海绵窦、视神经鞘、枕骨大孔区及颈静脉孔区等),SimpsonⅡ级,SimpsonⅢ级,SimpsonⅣ切除为导致术后并发症的独立危险因素。发生术后并发症的风险随手术切除程度的降低而升高,在年龄≥60岁时随年龄升高而升高。结论:颅内脑膜瘤有其流行病学及临床特征:女性高发,发病高峰有提前趋势,本中心患者最多来自于豫南地区,大脑镰和矢状窦旁高发,最常见的症状为头痛头昏,最常见的术后神经系统并发症为颅内出血等。患者年龄≥60岁、术前KPS≤70分、肿瘤≥7cm、肿瘤位于鞍区或其他罕见部位(海绵窦、原发视神经鞘、枕骨大孔区及颈静脉孔区等)及SimpsonⅡ/Ⅲ/Ⅳ级切除为发生术后并发症的独立危险因素。发生术后并发症的危险性随手术切除程度的降低而升高,在年龄≥60岁时随年龄升高而升高。脑膜瘤的治疗应合理评估患者术前情况,避免这些产生术后并发症的危险因素。对术后并发症,应根据情况密切观察或对症治疗。
[Abstract]:Objective: to summarize and analyze the epidemiological characteristics, postoperative complications and factors leading to postoperative complications of intracranial meningiomas, and to provide help for the clinical study and treatment of intracranial meningiomas. Methods: according to the WHO 2016 criteria for classification of central nervous system tumors, 2384 cases of intracranial meningioma were retrospectively analyzed from January 2012 to December 2016 in the Neurosurgery Department of the first affiliated Hospital of Zhengzhou University. Sex, age, regional distribution, clinical manifestation, tumor location, tumor size, surgical resection degree, pathological type, postoperative complications and other epidemiological features were described. The qualitative data of the two groups were compared by 蠂 2 test. Multivariate logistic regression analysis was used to analyze the related factors of postoperative complications. Then the epidemiological characteristics and treatment experience of intracranial meningioma were summarized in combination with clinical and related literature. Results the ratio of male to female was 1: 2.48 in 2 234 cases of intracranial meningioma. The number of female cases in each age group was higher than that in male group. The average age of the patients was 52.9 卤12.2 years. The peak age group was 50 to 59 years old. In Henan Province, the distribution of patients is the most in the south of Henan Province. The tumor was the smallest 0.4 cm and the maximum 12.3 cm, with an average of 3.8 卤1.5 cm. Most of the tumors were located in the cerebral falx and sagittal sinus. The most common clinical manifestation is headache and dizziness. According to the standard of Simpson 鈪，

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