桥小脑角区肿瘤切除术中影响面神经电生理监测准确性的因素分析

发布时间：2018-04-29 23:21

本文选题：桥小脑角区 + 听神经瘤　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:探讨在桥小脑角(CPA)区肿瘤切除术中对面神经电生理监测判断起干扰作用的相关因素。为神经外科手术过程中神经电生理监测的临床应用提供参考。方法:回顾性分析山西医科大学第一医院神经外科从2007年6月至2016年12月符合纳入标准的108例CPA区肿瘤切除术中行面神经电生理监测病例的完整资料。手术医师均为本院或外院著名神经外科专家,专业人员行术中面神经电生理监测。根据术中面神经电生理监测结果和术后面神经功能恢复情况是否一致分一致组和不一致组,不一致组包括假阳性和假阴性病例。应用统计学软件分析CPA区肿瘤手术中各种因素对面神经电生理监测判断准确性的影响,描素各影响因素与不一致组发生率(假阳性率和假阴性率)之间的相关关系。结果:(1)本组108例CPA区肿瘤切除术中行面神经电生理监测患者术后面神经功能恢复较好95例(占88.0%),较差13例(占12.0%);肿瘤全切除87例(占80.6%),部分切除21例(占19.4%);共产生不一致组病例38例(占35.0%)。(2)单因素统计学分析得出性别、年龄、肿瘤性质、肿瘤大小和病程不影响面神经电生理监测准确性(p0.05),肿瘤是否全切与术中PCO_2影响面神经电生理监测准确性(p0.05);多因素Logistic回归分析得出肿瘤是否全切与术中PCO_2影响CPA区肿瘤切除手术中面神经电生理监测的准确性。根据OR值可得出当术中PCO_235mmHg时,发生术中电生理监测结果与术后面神经功能保留情况不一致的风险将会增加2.799倍(OR=3.799,OR95%CI:1.478~9.762);当肿瘤全部切除的时候,发生不一致的风险将会增加4.142倍(OR=5.142,OR95%CI:1.105~23.920)。但二者OR值95%CI区间偏大,OR值可参考程度不高。结论:术中PCO_2和肿瘤切除情况影响CPA区肿瘤切除术中面神经电生理监测判断的准确性。桥小脑角(CPA)区肿瘤切除手术中,应用神经电生理监测能够有效提高患者面神经保留率。
[Abstract]:Objective: to investigate the factors that interfere with the electrophysiological monitoring of facial nerve in the resection of tumors in the cerebellopontine angle (CPA) area. To provide a reference for the clinical application of neurophysiological monitoring during neurosurgery. Methods: the complete data of 108 cases of facial electrophysiologic monitoring in the first Hospital of Shanxi Medical University from June 2007 to December 2016 were analyzed retrospectively. Surgeons are famous neurosurgical experts in our hospital or outside hospital, and professional personnel perform electrophysiological monitoring of facial nerve during operation. According to the results of electrophysiological monitoring of facial nerve during operation and the recovery of facial nerve function after operation, the patients were divided into consistent group and inconsistent group, including false positive and false negative cases. Statistical software was used to analyze the influence of various factors on the accuracy of electrophysiological monitoring of facial nerve in CPA area, and the correlation between the influencing factors and the incidence rate (false positive rate and false negative rate) in inconsistent group. Results in this group of 108 cases of CPA area tumor resection, 95 cases (88.0%, 13 cases poor), 87 cases (80.6%) total resection, 21 cases (19.4%) partial resection, 95 cases (88.0%), 13 cases (12.0%) had better recovery of facial nerve function after facial electrophysiologic monitoring, 87 cases (80.6%) were totally resected, 21 cases (19.4%) were partly resected. There were 38 cases (35.0%, 35.0%) in the group of birth inconsistency, and the sex was obtained by statistical analysis of the single factor. Age, tumor nature, The accuracy of electrophysiological monitoring of facial nerve was not affected by tumor size and course of disease, and the accuracy of electrophysiological monitoring of facial nerve was not affected by total resection of the tumor and intraoperative PCO_2. Multivariate Logistic regression analysis showed whether the tumor was totally removed and PCO_2 affected the CPA area during operation. Accuracy of electrophysiological monitoring of facial nerve during tumor resection. According to OR value, the risk of intraoperative electrophysiologic monitoring inconsistent with postoperative facial nerve function retention was increased by 2.799 times when PCO_235mmHg was performed, and when the tumor was resected completely, the risk of inconsistency would increase 4.142 times, and the risk of inconsistency would increase by 4.142 times. But the OR value of the two 95%CI values is too large and the OR value is not high. Conclusion: intraoperative PCO_2 and tumor resection affect the accuracy of electrophysiologic monitoring of facial nerve in CPA area tumor resection. During the resection of the tumors in the cerebellopontine angle (CPA) area, the application of electrophysiological monitoring can effectively improve the rate of facial nerve preservation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.4

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