發(fā)布時間：2018-04-29 23:21

  本文選題：橋小腦角區(qū) + 聽神經(jīng)瘤��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討在橋小腦角(CPA)區(qū)腫瘤切除術(shù)中對面神經(jīng)電生理監(jiān)測判斷起干擾作用的相關(guān)因素。為神經(jīng)外科手術(shù)過程中神經(jīng)電生理監(jiān)測的臨床應(yīng)用提供參考。方法:回顧性分析山西醫(yī)科大學(xué)第一醫(yī)院神經(jīng)外科從2007年6月至2016年12月符合納入標(biāo)準(zhǔn)的108例CPA區(qū)腫瘤切除術(shù)中行面神經(jīng)電生理監(jiān)測病例的完整資料。手術(shù)醫(yī)師均為本院或外院著名神經(jīng)外科專家,專業(yè)人員行術(shù)中面神經(jīng)電生理監(jiān)測。根據(jù)術(shù)中面神經(jīng)電生理監(jiān)測結(jié)果和術(shù)后面神經(jīng)功能恢復(fù)情況是否一致分一致組和不一致組,不一致組包括假陽性和假陰性病例。應(yīng)用統(tǒng)計學(xué)軟件分析CPA區(qū)腫瘤手術(shù)中各種因素對面神經(jīng)電生理監(jiān)測判斷準(zhǔn)確性的影響,描素各影響因素與不一致組發(fā)生率(假陽性率和假陰性率)之間的相關(guān)關(guān)系。結(jié)果:(1)本組108例CPA區(qū)腫瘤切除術(shù)中行面神經(jīng)電生理監(jiān)測患者術(shù)后面神經(jīng)功能恢復(fù)較好95例(占88.0%),較差13例(占12.0%);腫瘤全切除87例(占80.6%),部分切除21例(占19.4%);共產(chǎn)生不一致組病例38例(占35.0%)。(2)單因素統(tǒng)計學(xué)分析得出性別、年齡、腫瘤性質(zhì)、腫瘤大小和病程不影響面神經(jīng)電生理監(jiān)測準(zhǔn)確性(p0.05),腫瘤是否全切與術(shù)中PCO_2影響面神經(jīng)電生理監(jiān)測準(zhǔn)確性(p0.05);多因素Logistic回歸分析得出腫瘤是否全切與術(shù)中PCO_2影響CPA區(qū)腫瘤切除手術(shù)中面神經(jīng)電生理監(jiān)測的準(zhǔn)確性。根據(jù)OR值可得出當(dāng)術(shù)中PCO_235mmHg時,發(fā)生術(shù)中電生理監(jiān)測結(jié)果與術(shù)后面神經(jīng)功能保留情況不一致的風(fēng)險將會增加2.799倍(OR=3.799,OR95%CI:1.478~9.762);當(dāng)腫瘤全部切除的時候,發(fā)生不一致的風(fēng)險將會增加4.142倍(OR=5.142,OR95%CI:1.105~23.920)。但二者OR值95%CI區(qū)間偏大,OR值可參考程度不高。結(jié)論:術(shù)中PCO_2和腫瘤切除情況影響CPA區(qū)腫瘤切除術(shù)中面神經(jīng)電生理監(jiān)測判斷的準(zhǔn)確性。橋小腦角(CPA)區(qū)腫瘤切除手術(shù)中,應(yīng)用神經(jīng)電生理監(jiān)測能夠有效提高患者面神經(jīng)保留率。
[Abstract]:Objective: to investigate the factors that interfere with the electrophysiological monitoring of facial nerve in the resection of tumors in the cerebellopontine angle (CPA) area. To provide a reference for the clinical application of neurophysiological monitoring during neurosurgery. Methods: the complete data of 108 cases of facial electrophysiologic monitoring in the first Hospital of Shanxi Medical University from June 2007 to December 2016 were analyzed retrospectively. Surgeons are famous neurosurgical experts in our hospital or outside hospital, and professional personnel perform electrophysiological monitoring of facial nerve during operation. According to the results of electrophysiological monitoring of facial nerve during operation and the recovery of facial nerve function after operation, the patients were divided into consistent group and inconsistent group, including false positive and false negative cases. Statistical software was used to analyze the influence of various factors on the accuracy of electrophysiological monitoring of facial nerve in CPA area, and the correlation between the influencing factors and the incidence rate (false positive rate and false negative rate) in inconsistent group. Results in this group of 108 cases of CPA area tumor resection, 95 cases (88.0%, 13 cases poor), 87 cases (80.6%) total resection, 21 cases (19.4%) partial resection, 95 cases (88.0%), 13 cases (12.0%) had better recovery of facial nerve function after facial electrophysiologic monitoring, 87 cases (80.6%) were totally resected, 21 cases (19.4%) were partly resected. There were 38 cases (35.0%, 35.0%) in the group of birth inconsistency, and the sex was obtained by statistical analysis of the single factor. Age, tumor nature, The accuracy of electrophysiological monitoring of facial nerve was not affected by tumor size and course of disease, and the accuracy of electrophysiological monitoring of facial nerve was not affected by total resection of the tumor and intraoperative PCO_2. Multivariate Logistic regression analysis showed whether the tumor was totally removed and PCO_2 affected the CPA area during operation. Accuracy of electrophysiological monitoring of facial nerve during tumor resection. According to OR value, the risk of intraoperative electrophysiologic monitoring inconsistent with postoperative facial nerve function retention was increased by 2.799 times when PCO_235mmHg was performed, and when the tumor was resected completely, the risk of inconsistency would increase 4.142 times, and the risk of inconsistency would increase by 4.142 times. But the OR value of the two 95%CI values is too large and the OR value is not high. Conclusion: intraoperative PCO_2 and tumor resection affect the accuracy of electrophysiologic monitoring of facial nerve in CPA area tumor resection. During the resection of the tumors in the cerebellopontine angle (CPA) area, the application of electrophysiological monitoring can effectively improve the rate of facial nerve preservation.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李佳玉;金立民;吳津;張曉暄;宋雪松;;部分神經(jīng)肌肉阻滯下七氟烷或丙泊酚復(fù)合瑞芬太尼應(yīng)用于老年腦干腫瘤手術(shù)對誘發(fā)電位監(jiān)測的影響[J];中國老年學(xué)雜志;2016年13期

2 張e，

本文編號：1822031