颅咽管瘤认知功能与心理学分析及相关性研究

发布时间：2018-03-08 18:10

本文选题：颅咽管瘤　切入点：认知功能　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨颅咽管瘤患者经翼点入路手术前后认知功能及心理学的变化。重点探究颅咽管瘤患者的术前与术后的人格特征,探讨肿瘤的侵袭程度及手术对颅咽管瘤患者人格特征的影响。方法:对2014年9月至2016年9月收治的符合要求的22例成人颅咽管瘤患者进行术前认知功能及心理学相关测试,测试内容包括韦氏智力测试、及心理学MMPI人格测试等。将病例分组为翼点入路入路组和非翼点入路路组,在术前及术后对各组患者分别进行韦氏智力测验量及明尼苏达多项人格测试(MMPI)的问卷调查,共收集资料25例,将术前、术后及中国常模的各量表评分进行比较。结果:术前共纳入36例病例,术后随访到25例,其中23例为颅咽管瘤,2例为畸胎瘤。22例颅咽管瘤病例(1例数据因测试不全筛除)术后IQ成绩73%处于正常水平。经翼点入路组与非翼点人路组在术前总IQ差异、术后总IQ差异均无明显统计学意义。经翼点入路与非翼点入路组病例术后IQ成绩较术前提高具有统计学意义(p=0.013),两组病例在工作记忆及短期记忆中的差异无明显差异。术后IQ成绩在不同性别及激素水平是否正常组间的差异无统计学意义。术前患者各分量表在Hs、D、Hy、Pd、Pt、Sc指标上与常模相比有统计学意义,颅咽管瘤患者的得分均值大于常模。术后患者在D、Si指标上与术前相比有统计学意义(P0.05)。肿瘤分级与MMPI各分量表之间的关系显示,Type 2级患者在术前的Hy、Pd、Ma指标上较其他分级显著增高。结论:经翼点手术人路较非经翼点入路对术后患者学习能力可能有影响,可能造成患者术后学习新事物效率轻度下降及智力水平较术前下降,但其影响因素尚需进一步探讨。术后并发症的多少与严重程度可能影响术后智力水平变化。颅咽管瘤患者type2级与type 0级及type 1级比较术前术后人格特征的改变有显著差异,提示肿瘤对下丘脑的侵犯程度是患者认知与人格特征改变的重要影响因素。手术对下丘脑及邻近边缘系统的保护和术前术后的心理学辅导至关重要。
[Abstract]:Objective: to investigate the changes of cognitive function and psychology in patients with craniopharyngioma before and after pterygoid approach. To investigate the influence of tumor invasion and operation on personality characteristics of craniopharyngioma patients. Methods: from September 2014 to September 2016, 22 adult patients with craniopharyngioma were examined by preoperative cognitive and psychological tests. The patients were divided into pterional approach group and non-pterygoid approach group. Wechsler Intelligence Test and Minnesota multiple Personality Test (MMPI) were administered to 25 patients before and after operation. Results: 36 cases were included before operation and 25 cases were followed up after operation. Among them, 23 cases were craniopharyngioma. 2 cases were teratoma. 22 cases had craniopharyngioma. 1 case was removed because of incomplete examination. IQ scores of 73% cases were normal after operation. The total IQ of the transpterional approach group and the non-pterygoid point human approach group were different before operation. There was no significant difference in total IQ between the two groups. The scores of IQ in the transpterional approach group and non-pterygoid approach group were significantly higher than those in the preoperative group. There was no significant difference in working memory and short-term memory between the two groups. There was no significant difference in IQ scores between different genders and whether the hormone levels were normal or not. There was statistical significance between the subscales of preoperative patients and the norm. The average score of patients with craniopharyngioma was higher than that of the norm. There was significant difference between postoperative patients and pre-operative patients in terms of DG Si index (P 0.05). The relationship between tumor grade and MMPI subscales showed that the patients with grade 2 had higher preoperative Hydro Pdlma than other indexes before operation. Conclusion: the transpterional approach may have an effect on the learning ability of the patients after operation compared with the non-pterygoid approach. This may result in a slight decrease in the efficiency of learning new things and a decrease in the level of intelligence after surgery. However, the influencing factors need to be further explored. The number and severity of postoperative complications may affect the changes of postoperative intelligence. There are significant differences in the changes of preoperative and postoperative personality characteristics between type2 grade and type grade 0 and type grade 1 in patients with craniopharyngioma. It is suggested that the degree of invasion of the hypothalamus is an important factor in the change of cognitive and personality characteristics of the patients, and that surgery is of great importance to the protection of the hypothalamus and its adjacent limbic system and psychological counseling before and after operation.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.4

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