發(fā)布時(shí)間：2018-03-20 03:35

  本文選題：惡性腦膜瘤　切入點(diǎn)：臨床特點(diǎn)　出處：《西南醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過(guò)對(duì)比良性腦膜瘤和惡性腦膜瘤的臨床特點(diǎn)、影像學(xué)情況、手術(shù)情況、病理及免疫組化情況,分析惡性腦膜瘤具有的臨床特征,明確影響其復(fù)發(fā)的獨(dú)立因素。方法:收集于2002年1月~2015年12月在瀘州醫(yī)學(xué)院附屬醫(yī)院神經(jīng)外科就診、接受開(kāi)顱手術(shù)且術(shù)后病理結(jié)果證實(shí)為惡性腦膜瘤的24例患者的臨床資料。并在同期同主刀醫(yī)師手術(shù)患者中隨機(jī)選擇24例資料完整的良性腦膜瘤為對(duì)照組�；仡櫺苑治隽紣盒阅X膜瘤患者在臨床特點(diǎn)、影像學(xué)表現(xiàn)、手術(shù)和術(shù)后隨訪情況,并進(jìn)行統(tǒng)計(jì)學(xué)分析。通過(guò)檢測(cè)免疫組化標(biāo)本中Ki67、EMA、Vimentin和CyclinE生物學(xué)指標(biāo)的表達(dá)來(lái)分析良惡性腦膜瘤在病理學(xué)上的差異。結(jié)合這些臨床特征,對(duì)各指標(biāo)與惡性腦膜瘤術(shù)后復(fù)發(fā)的相關(guān)性進(jìn)行Kaplan-Meier單因素分析,對(duì)有意義者再行Cox多因素回歸分析,并結(jié)合既往文獻(xiàn)回顧結(jié)果分析判斷影響惡性腦膜瘤復(fù)發(fā)的獨(dú)立因素。結(jié)果:良惡性腦膜瘤在性別、發(fā)病年齡、生長(zhǎng)部位、腫瘤大小以及臨床癥狀體征等一般臨床特點(diǎn)上無(wú)明顯差異(P0.05);而在死亡率、復(fù)發(fā)率、CT平掃鈣化、增強(qiáng)MRI強(qiáng)化、瘤周水腫以及Ki-67標(biāo)記指數(shù)和手術(shù)切除程度上差異明顯(P0.05)。惡性腦膜瘤各臨床特征與術(shù)后復(fù)發(fā)之間的關(guān)系的分析結(jié)果:年齡(P=0.009)、瘤周水腫程度(P=0.005)、腫瘤大小(P=0.050)、侵襲性類型(P=0.011)和手術(shù)切除程度(P=0.002)具有判斷惡性腦膜瘤術(shù)后復(fù)發(fā)的價(jià)值。但經(jīng)多因素回歸分析后,剔除侵襲性類型(RR=0.699,95%CI:0.184~2.658,P=0.600)、瘤周水腫程度(RR=2.915,95%CI:0.881~9.648,P=0.080)和腫瘤大小(RR=1.314,95%CI:0.250~6.921,P=0.747),僅有年齡(RR=4.379,95%CI:1.125~17.051,P=0.033)和手術(shù)切除程度(RR=3.442,95%CI:1.314~9.016,P=0.012)具有統(tǒng)計(jì)學(xué)意義。結(jié)論:1、目前少有關(guān)于惡性腦膜瘤復(fù)發(fā)和預(yù)后的研究且各研究結(jié)果間異質(zhì)性較大。在惡性腦膜瘤臨床特征與復(fù)發(fā)間相關(guān)性的生存分析模型中,腫瘤侵襲性類型、瘤周水腫程度和腫瘤大小可能影響患者復(fù)發(fā),年齡和手術(shù)切除程度是影響惡性腦膜瘤復(fù)發(fā)的獨(dú)立因素。2、惡性腦膜瘤具有低發(fā)病率、高復(fù)發(fā)率、高死亡率、磁共振不均勻強(qiáng)化和高度瘤周水腫等臨床特點(diǎn)。3、免疫組化Ki-67標(biāo)記指數(shù)對(duì)良惡性腦膜瘤具有鑒別診斷價(jià)值。4、手術(shù)治療是目前惡性腦膜瘤的首選治療方式,盡全切腫瘤可控制惡性腦膜瘤復(fù)發(fā),改善預(yù)后。對(duì)所有惡性腦膜瘤患者,尤其是非全切除的惡性腦膜瘤患者行輔助放療,是必不可少的。
[Abstract]:Objective: to analyze the clinical features of benign meningioma and malignant meningioma by comparing their clinical features, imaging, operation, pathology and immunohistochemistry. Methods: from January 2002 to December 2015, the patients were treated in neurosurgery department, affiliated hospital of Luzhou Medical College. The clinical data of 24 cases of malignant meningioma confirmed by craniotomy and pathologically confirmed. 24 cases of benign meningioma with complete data were randomly selected as control group in the same period. To analyze the clinical features of benign and malignant meningiomas, Imaging findings, surgical and postoperative follow-up, and statistical analysis. The pathological differences of benign and malignant meningiomas were analyzed by detecting the expression of Ki67 EMAVimentin and CyclinE in immunohistochemical specimens. The correlation between the indexes and the recurrence of malignant meningioma after operation was analyzed by Kaplan-Meier univariate analysis, and Cox multivariate regression analysis was performed on the significant patients. The independent factors affecting the recurrence of malignant meningioma were analyzed and judged by reviewing the results of previous literature. Results: benign and malignant meningiomas were located in sex, age of onset and location of growth. There was no significant difference in the size of tumor and clinical symptoms and signs in general clinical features (P 0.05), but in mortality, recurrence rate, CT plain calcification, enhanced MRI enhancement, and no significant difference in general clinical features, such as tumor size, clinical symptoms and signs, etc. There were significant differences in peritumoral edema, Ki-67 labeling index and surgical excision degree. The relationship between the clinical features of malignant meningioma and postoperative recurrence was significant (P 0.05). The results showed that the age of malignant meningioma was 0.009, the degree of peritumoral edema was P0.005, the size of tumor was 0.050%, and the invasive type of malignant meningioma was found. It is valuable to judge the recurrence of malignant meningioma after operation, but after multivariate regression analysis. Excluding the invasive type RRN 0.69995 CI: 0.1844 2.658P0.600, the degree of peritumoral edema is 2.91595CI0.8819.648P0.080) and the size of the tumor RRN1.314995: CI0.2506.921P0.47470.4747, only the age of RRR4.37995CI1.1255.95CI1.12517.051P0.033) and the degree of excision RR3.44295CI1.314149.016P0.012) have statistical significance. Conclusion 1, there are few studies on the recurrence and prognosis of malignant meningioma. In the survival analysis model of the correlation between clinical characteristics and recurrence of malignant meningioma, The invasive type of tumor, the degree of peritumoral edema and the size of tumor may affect the recurrence of patients. Age and surgical resection degree are independent factors affecting the recurrence of malignant meningioma. The malignant meningioma has low incidence, high recurrence rate and high mortality. The clinical features of magnetic resonance inhomogeneous enhancement and high peritumoral edema. The immunohistochemical Ki-67 labeling index is valuable for differential diagnosis of benign and malignant meningiomas. Surgical treatment is the first choice of treatment for malignant meningiomas at present. Total resection of the tumor can control the recurrence of malignant meningioma and improve the prognosis. It is necessary to perform adjuvant radiotherapy for all patients with malignant meningioma, especially those with incomplete resection of malignant meningioma.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.45

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