【摘要】：目的：研究顱底中央?yún)^(qū)腦膜瘤的臨床特點(diǎn),探討顯微手術(shù)治療后腫瘤復(fù)發(fā)的影響因素。 資料和方法：回顧性分析中南大學(xué)湘雅醫(yī)院神經(jīng)外科1993年12月至2013年9月由袁賢瑞教授主刀手術(shù)的414例顱底中央?yún)^(qū)腦膜瘤患者的臨床資料并進(jìn)行隨訪研究。主要包括：一般資料、臨床特征、影像學(xué)表現(xiàn)、手術(shù)資料、病理結(jié)果、有無復(fù)發(fā)等。對可能影響患者腫瘤術(shù)后復(fù)發(fā)的影響因素分別進(jìn)行統(tǒng)計(jì)學(xué)分析。 414例患者首次手術(shù)全切336例,其中男性108例,女性228例,男女比例1：2.11,首次發(fā)病年齡6-79歲,平均47.50歲,首次發(fā)病病程1天-20年,中位數(shù)5.9月。臨床表現(xiàn)以顱高壓起病患者147例,以癲癇起病40例,以局部壓迫癥狀起病的182例,以精神改變或智力下降起病的患者28例。首次手術(shù)術(shù)中行Simpson Ⅰ級切除患者77例,術(shù)中行Simpson Ⅱ級切除患者259例。病理等級為WHO Ⅰ級患者319例,WHO Ⅱ級患者12例,WHO Ⅲ級患者5例。鞍結(jié)節(jié)及鞍隔腦膜瘤組共有患者150例,前床突及蝶骨嵴內(nèi)側(cè)腦膜瘤組114例,巖斜坡及巖斜蝶腦膜瘤組62例,海綿竇組10例。 結(jié)果：首次手術(shù)腫瘤全切除患者336例,全切除后復(fù)發(fā)39例,占11.6%。術(shù)中行Simpson Ⅰ級切除患者腫瘤復(fù)發(fā)率(2.6%)低于術(shù)中行Simpson Ⅱ級患者復(fù)發(fā)率(14.3%)；腫瘤病理等級越高,患者復(fù)發(fā)率越高；腫瘤基底起源于海綿竇或和海綿竇關(guān)系密切的腫瘤患者術(shù)后復(fù)發(fā)率較高。有骨質(zhì)破壞、有瘤內(nèi)壞死的顱底中央?yún)^(qū)腦膜瘤復(fù)發(fā)率較高。 結(jié)論：1.顱底中央?yún)^(qū)腦膜瘤復(fù)發(fā)的高危因素包括：患者發(fā)病年齡、術(shù)中切除程度、腫瘤病理等級、腫瘤位置、腫瘤形態(tài)、骨質(zhì)變化、瘤周水腫、瘤內(nèi)壞死。 2.對于腦膜瘤復(fù)發(fā)高危人群,術(shù)中應(yīng)盡可能徹底切除腫瘤及受累及硬腦膜,可降低腫瘤復(fù)發(fā)率。
[Abstract]:Objective: to study the clinical features of meningioma in the central region of the skull base and to explore the influencing factors of tumor recurrence after microsurgical treatment. Materials and methods: the clinical data of 414 patients with meningioma in the central part of the skull base who were operated by Professor Yuan Xianrui from December 1993 to September 2013 in Xiangya Hospital of Central South University were retrospectively analyzed and followed up. Include: general data, clinical features, imaging manifestations, surgical data, pathological results, recurrence and so on. The factors that may affect the recurrence of tumor after operation were analyzed statistically. There were 336 cases of total operation in 414 patients, including 108 males and 228 females, the ratio of male to female was 1: 2.11. The first onset age was 6-79 years old (mean 47.50 years). The course of the first onset was from 1 day to 20 years, with a median of 5.9 months. The clinical manifestations included 147 cases of cranial hypertension, 40 cases of epilepsy, 182 cases of local compression, and 28 cases of mental disorder or mental retardation. There were 77 cases of Simpson 鈪，

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