本文選題：顱咽管瘤　切入點(diǎn)：認(rèn)知功能　出處：《新疆醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討顱咽管瘤患者經(jīng)翼點(diǎn)入路手術(shù)前后認(rèn)知功能及心理學(xué)的變化。重點(diǎn)探究顱咽管瘤患者的術(shù)前與術(shù)后的人格特征,探討腫瘤的侵襲程度及手術(shù)對(duì)顱咽管瘤患者人格特征的影響。方法:對(duì)2014年9月至2016年9月收治的符合要求的22例成人顱咽管瘤患者進(jìn)行術(shù)前認(rèn)知功能及心理學(xué)相關(guān)測(cè)試,測(cè)試內(nèi)容包括韋氏智力測(cè)試、及心理學(xué)MMPI人格測(cè)試等。將病例分組為翼點(diǎn)入路入路組和非翼點(diǎn)入路路組,在術(shù)前及術(shù)后對(duì)各組患者分別進(jìn)行韋氏智力測(cè)驗(yàn)量及明尼蘇達(dá)多項(xiàng)人格測(cè)試(MMPI)的問卷調(diào)查,共收集資料25例,將術(shù)前、術(shù)后及中國(guó)常模的各量表評(píng)分進(jìn)行比較。結(jié)果:術(shù)前共納入36例病例,術(shù)后隨訪到25例,其中23例為顱咽管瘤,2例為畸胎瘤。22例顱咽管瘤病例(1例數(shù)據(jù)因測(cè)試不全篩除)術(shù)后IQ成績(jī)73%處于正常水平。經(jīng)翼點(diǎn)入路組與非翼點(diǎn)人路組在術(shù)前總IQ差異、術(shù)后總IQ差異均無(wú)明顯統(tǒng)計(jì)學(xué)意義。經(jīng)翼點(diǎn)入路與非翼點(diǎn)入路組病例術(shù)后IQ成績(jī)較術(shù)前提高具有統(tǒng)計(jì)學(xué)意義(p=0.013),兩組病例在工作記憶及短期記憶中的差異無(wú)明顯差異。術(shù)后IQ成績(jī)?cè)诓煌詣e及激素水平是否正常組間的差異無(wú)統(tǒng)計(jì)學(xué)意義。術(shù)前患者各分量表在Hs、D、Hy、Pd、Pt、Sc指標(biāo)上與常模相比有統(tǒng)計(jì)學(xué)意義,顱咽管瘤患者的得分均值大于常模。術(shù)后患者在D、Si指標(biāo)上與術(shù)前相比有統(tǒng)計(jì)學(xué)意義(P0.05)。腫瘤分級(jí)與MMPI各分量表之間的關(guān)系顯示,Type 2級(jí)患者在術(shù)前的Hy、Pd、Ma指標(biāo)上較其他分級(jí)顯著增高。結(jié)論:經(jīng)翼點(diǎn)手術(shù)人路較非經(jīng)翼點(diǎn)入路對(duì)術(shù)后患者學(xué)習(xí)能力可能有影響,可能造成患者術(shù)后學(xué)習(xí)新事物效率輕度下降及智力水平較術(shù)前下降,但其影響因素尚需進(jìn)一步探討。術(shù)后并發(fā)癥的多少與嚴(yán)重程度可能影響術(shù)后智力水平變化。顱咽管瘤患者type2級(jí)與type 0級(jí)及type 1級(jí)比較術(shù)前術(shù)后人格特征的改變有顯著差異,提示腫瘤對(duì)下丘腦的侵犯程度是患者認(rèn)知與人格特征改變的重要影響因素。手術(shù)對(duì)下丘腦及鄰近邊緣系統(tǒng)的保護(hù)和術(shù)前術(shù)后的心理學(xué)輔導(dǎo)至關(guān)重要。
[Abstract]:Objective: to investigate the changes of cognitive function and psychology in patients with craniopharyngioma before and after pterygoid approach. To investigate the influence of tumor invasion and operation on personality characteristics of craniopharyngioma patients. Methods: from September 2014 to September 2016, 22 adult patients with craniopharyngioma were examined by preoperative cognitive and psychological tests. The patients were divided into pterional approach group and non-pterygoid approach group. Wechsler Intelligence Test and Minnesota multiple Personality Test (MMPI) were administered to 25 patients before and after operation. Results: 36 cases were included before operation and 25 cases were followed up after operation. Among them, 23 cases were craniopharyngioma. 2 cases were teratoma. 22 cases had craniopharyngioma. 1 case was removed because of incomplete examination. IQ scores of 73% cases were normal after operation. The total IQ of the transpterional approach group and the non-pterygoid point human approach group were different before operation. There was no significant difference in total IQ between the two groups. The scores of IQ in the transpterional approach group and non-pterygoid approach group were significantly higher than those in the preoperative group. There was no significant difference in working memory and short-term memory between the two groups. There was no significant difference in IQ scores between different genders and whether the hormone levels were normal or not. There was statistical significance between the subscales of preoperative patients and the norm. The average score of patients with craniopharyngioma was higher than that of the norm. There was significant difference between postoperative patients and pre-operative patients in terms of DG Si index (P 0.05). The relationship between tumor grade and MMPI subscales showed that the patients with grade 2 had higher preoperative Hydro Pdlma than other indexes before operation. Conclusion: the transpterional approach may have an effect on the learning ability of the patients after operation compared with the non-pterygoid approach. This may result in a slight decrease in the efficiency of learning new things and a decrease in the level of intelligence after surgery. However, the influencing factors need to be further explored. The number and severity of postoperative complications may affect the changes of postoperative intelligence. There are significant differences in the changes of preoperative and postoperative personality characteristics between type2 grade and type grade 0 and type grade 1 in patients with craniopharyngioma. It is suggested that the degree of invasion of the hypothalamus is an important factor in the change of cognitive and personality characteristics of the patients, and that surgery is of great importance to the protection of the hypothalamus and its adjacent limbic system and psychological counseling before and after operation.
【學(xué)位授予單位】：新疆醫(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)】：R739.4

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