大脑镰旁脑膜瘤的临床特点及手术预后分析

发布时间：2018-05-05 03:22

本文选题：镰旁脑膜瘤 + 分型　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探究大脑镰旁脑膜瘤的临床特点及手术预后。方法:回顾性分析我院自2010年1月至2015年12月期间收治的大脑镰旁脑膜瘤的患者共95例。根据其肿瘤在大脑镰上生长部位不同,以冠状缝和人字缝为界,将其分为前部型、中部型以及后部型3组。通过t检验、方差分析、χ2检验等方法分析其临床表现、肿瘤特点、手术预后等情况,探讨三种类型镰旁脑膜瘤存在的差异,指导其手术方案选择及手术预后评估。结果:在本组数据中,肿瘤达到全切的85例,全切率89.5%;术后有并发症的30例,发生率31.6%,有永久性神经功能障碍的4例,发生率4.2%,复发/进展的有6例,复发率6.3%,死亡1例,死亡率1.0%,治疗后KPS评分改善的83例(87.4%)。病理结果方面,纤维型、上皮型较常见,WHO I级有91例,良性率95.8%。分型来看,中部型(42例)和前部型(40例)是常见的生长部位,后部型(13例)相对少见。三种类型镰旁脑膜瘤在神经功能症状生率上,有统计学差异(p=0.026),中部型发生率最高。其中精神活动异常发生率无统计学差异(p=0.369);肢体肌力或感觉异常有统计学差异(p=0.006),中部型发生率最高;视力受损发生率有统计学差异(p=0.002),后部型最高。肿瘤全切率有统计学差异(p=0.048),前部型(97.5%)和后部型(92.3%)相对较高,中部型(81.0%)全切率相对更低。神经功能并发症发生率有统计学差异(p=0.030),中部型发生率最高;肢体肌力及感觉异常并发症发生率有统计学差异(p=0.003),中部型发生率最高。结论:大脑镰旁脑膜瘤手术治疗总体效果良好。中部型镰旁脑膜瘤神经功能症状特别是肢体肌力及感觉异常发生率更高,全切率较另两种类型低,术后神经功能并发症发生率相对更高。对于该类型的镰旁脑膜瘤,在围手术期管理及手术过程中,应更加谨慎。
[Abstract]:Objective: to investigate the clinical features and surgical prognosis of paraspinal meningioma. Methods: from January 2010 to December 2015, 95 patients with paraspinal meningioma in our hospital were retrospectively analyzed. According to the different growth sites of the tumors on the sickle, the tumors were divided into three groups: anterior type, middle type and posterior type, with coronal suture and herringbone suture as the boundary. T test, analysis of variance and 蠂 2 test were used to analyze the clinical manifestations, tumor characteristics and surgical prognosis. The differences among the three types of paraspinal meningiomas were discussed to guide the selection of surgical schemes and the evaluation of surgical prognosis. Results: in the data of this group, 85 cases of total resection were achieved, the rate of total resection was 89.5.The postoperative complications occurred in 30 cases (31.6%), and there were 4 cases of permanent neurological dysfunction (4.2%), 6 cases of recurrence / progression, 6.3% of recurrence rate and 1 case of death. The mortality rate was 1.0%, and 83 cases with improved KPS score after treatment were 87.4%. There were 91 cases of fibrous type and epithelial type in WHO grade I, the benign rate was 95.8%. The central type (42 cases) and the anterior type (40 cases) are common growth sites, while the posterior type (13 cases) are relatively rare. There was a significant difference in the incidence of neurologic symptoms among the three types of paraspinal meningiomas, and the incidence of middle type was the highest. There was no statistical difference in the incidence of abnormal mental activity (P < 0. 369), there was significant difference in limb muscle strength or sensory abnormality (P < 0. 006), the incidence of middle type was the highest, and the incidence of visual impairment was significantly different (P < 0. 002), and that of posterior type was the highest. The total resection rate of the tumor was higher than that of the middle type (P < 0.048), the anterior type was 97.5) and the posterior type was 92.32.The total resection rate was lower than that of the middle type (81.0%). The incidence of neurologic complications was significantly higher than that of middle type, and the incidence of limb muscle strength and sensory abnormality was significantly higher than that of middle type. Conclusion: the surgical treatment of paraspinal meningioma is effective on the whole. The incidence of neurologic symptoms, especially limb muscle strength and sensory abnormalities, was higher, the total resection rate was lower than the other two types, and the incidence of postoperative neurologic complications was higher than that of the other two types. More caution should be exercised in the perioperative management and operation of this type of paraspinal meningioma.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.45

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