本文選題：巖斜區(qū) + 腦膜瘤��； 參考：《上海交通大學(xué)》2015年博士論文

【摘要】：目的:分析總結(jié)顯微手術(shù)治療巖斜區(qū)腦膜瘤的效果,并初步探討手術(shù)入路的選擇,腫瘤切除程度的影響因素,患者預(yù)后的影響因素,來探索手術(shù)治療巖斜區(qū)腦膜瘤的最優(yōu)方案,提高手術(shù)治療效果和患者術(shù)后生活質(zhì)量。方法:回顧性分析上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院神經(jīng)外科從2010年1月到2014年12月顯微手術(shù)治療的24例巖斜區(qū)腦膜瘤患者的臨床資料、影像學(xué)資料、手術(shù)資料及隨訪資料。男性10例,女性14例,男女比為1:1.4,平均年齡(49.1±8.9)歲(31-62歲),平均病程(16.3±29.6)個(gè)月(0.1-120個(gè)月)�；颊咧饕Y狀包括飲水嗆咳、頭痛、行走不穩(wěn)、面部感覺異常、聽力下降、肌力下降、肢體感覺異常、面部疼痛、視力下降、復(fù)視等。腫瘤平均直徑(3.9±1.0)cm(2.3-5.5cm)。手術(shù)入路包括枕下乙狀竇后入路12例,乙狀竇前入路5例,顳下經(jīng)天幕入路5例,眶顴入路1例,遠(yuǎn)外側(cè)入路1例。結(jié)果:24例患者中,腫瘤完全切除(Simpson II級(jí))10例(41.7%),次全切除(Simpson III級(jí))6例(25%),大部分切除(Simpson IV級(jí))8例(33.3%)。術(shù)后并發(fā)癥包括顱內(nèi)感染1例(4.2%),肺部感染1例(4.2%),癲癇1例(4.2%),暫時(shí)性失語1例(4.2%)。術(shù)后新發(fā)神經(jīng)功能障礙包括動(dòng)眼神經(jīng)麻痹4例(16.7%),面神經(jīng)麻痹3例(12.5%),外展神經(jīng)麻痹2例(8.3%),偏癱2例(8.3%),三叉神經(jīng)功能障礙1例(4.2%)。無圍手術(shù)期死亡病例。24例患者全部得到隨訪,平均隨訪時(shí)間(31.4±17.5)個(gè)月(1-62個(gè)月),隨訪生活質(zhì)量優(yōu)秀18例(75.0%),生活質(zhì)量良好4例(16.7%),生活不能自理2例(8.3%),8例大部分切除患者中有4例行伽馬刀治療,1例行普通放療,未發(fā)現(xiàn)殘余腫瘤進(jìn)展或腫瘤復(fù)發(fā)病例。患者隨訪KPS評(píng)分與術(shù)前KPS評(píng)分(t=-2.174,P=0.040)和術(shù)后KPS評(píng)分(t=-3.301,P=0.003)的差異有統(tǒng)計(jì)學(xué)意義,腫瘤全切率與腫瘤質(zhì)地(P=0.022)、海綿竇侵犯(P=0.024)、腦干粘連程度(P=0.005)顯著相關(guān),腫瘤質(zhì)地對(duì)隨訪KPS評(píng)分有顯著影響(P=0.001)。結(jié)論:1.巖斜區(qū)腦膜瘤多為良性腫瘤,生長緩慢,且手術(shù)難度大,術(shù)后并發(fā)癥多,腫瘤直徑小于3cm且無臨床癥狀的患者可行定期影像學(xué)隨訪,一旦發(fā)現(xiàn)腫瘤直徑超過3cm或患者出現(xiàn)臨床癥狀,應(yīng)行手術(shù)治療;2.根據(jù)腫瘤特點(diǎn)選擇合適的手術(shù)入路,有利于提高腫瘤的全切率,枕下乙狀竇后入路是一種簡單、安全、有效的切除巖斜區(qū)腦膜瘤的手術(shù)入路;3.腫瘤切除程度與腫瘤質(zhì)地、海綿竇侵犯、腦干粘連程度顯著相關(guān);4.巖斜區(qū)腦膜瘤患者術(shù)后生活質(zhì)量與腫瘤質(zhì)地顯著相關(guān);5.輔助放射治療可以有效的控制巖斜區(qū)腦膜瘤的生長,降低腫瘤復(fù)發(fā)進(jìn)展率;6.充分的術(shù)前評(píng)估是十分重要的,綜合考慮腫瘤特點(diǎn)、患者自身情況、術(shù)者經(jīng)驗(yàn)及手術(shù)預(yù)期目標(biāo)等多方面因素,選擇正確合理的手術(shù)入路,制定個(gè)體化的治療方案,找到最大限度保留患者神經(jīng)功能和提高腫瘤切除程度之間的平衡點(diǎn),爭取獲得腫瘤的完全切除,有利于降低術(shù)后并發(fā)癥率,提高患者術(shù)后生活質(zhì)量。
[Abstract]:Objective: to analyze and summarize the effect of microsurgical treatment of petroclival meningioma, and to explore the choice of surgical approach, the factors influencing the degree of tumor resection and the factors influencing the prognosis of the patients, so as to explore the optimal treatment scheme for the patients with petroclival meningioma. To improve the effect of operation and the quality of life after operation. Methods: the clinical data, imaging data, surgical data and follow-up data of 24 patients with petroclival meningioma treated by microsurgery in Renji Hospital affiliated to Shanghai Jiaotong University from January 2010 to December 2014 were retrospectively analyzed. There were 10 males and 14 females, the ratio of males to females was 1: 1.4, the average age was 49.1 鹵8.9 years old and the mean course of disease was 16.3 鹵29.6months or 0.1-120 months. The main symptoms include drinking cough, headache, walking instability, abnormal facial sensation, hearing loss, muscle strength decline, limb sensory abnormality, facial pain, visual decline, diplopia and so on. The mean diameter of tumor was 3.9 鹵1.0 cm ~ (-1) cm ~ (2. 3) ~ 5.5 cm ~ (-1). The operative approach included retrosigmoid suboccipital approach (12 cases), anterior sigmoid sinus approach (5 cases), infratemporal transatentorial approach (5 cases), orbital zygomatic approach (1 case) and far lateral approach (1 case). Results among the 24 cases, 10 cases were resected completely, 6 cases had subtotal resection of III grade III and 8 cases had 3. 3%. Postoperative complications included intracranial infection in 1 case, pulmonary infection in 1 case, epilepsy in 1 case and transient aphasia in 1 case. Postoperative new nerve dysfunction included oculomotor palsy (n = 4), facial nerve palsy (n = 3), abducens nerve palsy (n = 2), hemiplegia (n = 2) and trigeminal nerve dysfunction (n = 1). All 24 patients with no perioperative death were followed up. The average follow-up time was 31. 4 鹵17. 5 months or 1-62 months. The quality of life was excellent in 18 cases. The quality of life was good in 4 cases, and 2 cases were unable to take care of themselves. Of the 8 cases with major resection, 4 cases were treated with gamma knife and 1 case was treated with conventional radiotherapy. No residual tumor progression or recurrence was found. There was a significant difference between the KPS scores of the patients and the preoperative KPS scores (P 0.040) and the postoperative KPS scores (t = -3.301 and P 0.003). The total tumor removal rate was significantly correlated with the quality of the tumor, the cavernous sinus invasion (P < 0.024), and the degree of brain stem adhesion (P 0.005), and the tumor texture had a significant effect on the KPS score (P 0.001). Conclusion 1. The patients with petrosal oblique meningioma are mostly benign tumors, whose growth is slow, the operation is difficult, and there are many postoperative complications. The patients whose tumor diameter is smaller than 3cm and have no clinical symptoms can be followed up regularly. Once the diameter of the tumor exceeds 3cm or the patient has clinical symptoms, surgical treatment should be performed. According to the characteristics of the tumor, choosing a suitable operative approach is helpful to improve the total resection rate of the tumor. The retrosigmoid suboccipital approach is a simple, safe and effective surgical approach for the resection of petroclival meningiomas. The degree of tumor resection was significantly correlated with tumor texture, cavernous sinus invasion and brain stem adhesion. There was a significant correlation between the quality of life and tumor texture in patients with petroclival meningioma. Adjuvant radiotherapy can effectively control the growth of petroclival meningioma and reduce the recurrence and progression rate of tumor. It is very important to evaluate the operation before operation. Taking into account the characteristics of tumor, the patient's own condition, the experience of the operator and the target of the operation, we should choose the correct and reasonable operative approach and make the individualized treatment plan. Finding the balance point between preserving the nerve function of the patients and improving the degree of tumor resection to obtain the complete resection of the tumor is helpful to reduce the rate of postoperative complications and improve the quality of life of the patients after operation.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R739.45

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