本文選題：鐮旁腦膜瘤 + 分型�。� 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探究大腦鐮旁腦膜瘤的臨床特點(diǎn)及手術(shù)預(yù)后。方法:回顧性分析我院自2010年1月至2015年12月期間收治的大腦鐮旁腦膜瘤的患者共95例。根據(jù)其腫瘤在大腦鐮上生長(zhǎng)部位不同,以冠狀縫和人字縫為界,將其分為前部型、中部型以及后部型3組。通過(guò)t檢驗(yàn)、方差分析、χ2檢驗(yàn)等方法分析其臨床表現(xiàn)、腫瘤特點(diǎn)、手術(shù)預(yù)后等情況,探討三種類型鐮旁腦膜瘤存在的差異,指導(dǎo)其手術(shù)方案選擇及手術(shù)預(yù)后評(píng)估。結(jié)果:在本組數(shù)據(jù)中,腫瘤達(dá)到全切的85例,全切率89.5%;術(shù)后有并發(fā)癥的30例,發(fā)生率31.6%,有永久性神經(jīng)功能障礙的4例,發(fā)生率4.2%,復(fù)發(fā)/進(jìn)展的有6例,復(fù)發(fā)率6.3%,死亡1例,死亡率1.0%,治療后KPS評(píng)分改善的83例(87.4%)。病理結(jié)果方面,纖維型、上皮型較常見,WHO I級(jí)有91例,良性率95.8%。分型來(lái)看,中部型(42例)和前部型(40例)是常見的生長(zhǎng)部位,后部型(13例)相對(duì)少見。三種類型鐮旁腦膜瘤在神經(jīng)功能癥狀生率上,有統(tǒng)計(jì)學(xué)差異(p=0.026),中部型發(fā)生率最高。其中精神活動(dòng)異常發(fā)生率無(wú)統(tǒng)計(jì)學(xué)差異(p=0.369);肢體肌力或感覺(jué)異常有統(tǒng)計(jì)學(xué)差異(p=0.006),中部型發(fā)生率最高;視力受損發(fā)生率有統(tǒng)計(jì)學(xué)差異(p=0.002),后部型最高。腫瘤全切率有統(tǒng)計(jì)學(xué)差異(p=0.048),前部型(97.5%)和后部型(92.3%)相對(duì)較高,中部型(81.0%)全切率相對(duì)更低。神經(jīng)功能并發(fā)癥發(fā)生率有統(tǒng)計(jì)學(xué)差異(p=0.030),中部型發(fā)生率最高;肢體肌力及感覺(jué)異常并發(fā)癥發(fā)生率有統(tǒng)計(jì)學(xué)差異(p=0.003),中部型發(fā)生率最高。結(jié)論:大腦鐮旁腦膜瘤手術(shù)治療總體效果良好。中部型鐮旁腦膜瘤神經(jīng)功能癥狀特別是肢體肌力及感覺(jué)異常發(fā)生率更高,全切率較另兩種類型低,術(shù)后神經(jīng)功能并發(fā)癥發(fā)生率相對(duì)更高。對(duì)于該類型的鐮旁腦膜瘤,在圍手術(shù)期管理及手術(shù)過(guò)程中,應(yīng)更加謹(jǐn)慎。
[Abstract]:Objective: to investigate the clinical features and surgical prognosis of paraspinal meningioma. Methods: from January 2010 to December 2015, 95 patients with paraspinal meningioma in our hospital were retrospectively analyzed. According to the different growth sites of the tumors on the sickle, the tumors were divided into three groups: anterior type, middle type and posterior type, with coronal suture and herringbone suture as the boundary. T test, analysis of variance and 蠂 2 test were used to analyze the clinical manifestations, tumor characteristics and surgical prognosis. The differences among the three types of paraspinal meningiomas were discussed to guide the selection of surgical schemes and the evaluation of surgical prognosis. Results: in the data of this group, 85 cases of total resection were achieved, the rate of total resection was 89.5.The postoperative complications occurred in 30 cases (31.6%), and there were 4 cases of permanent neurological dysfunction (4.2%), 6 cases of recurrence / progression, 6.3% of recurrence rate and 1 case of death. The mortality rate was 1.0%, and 83 cases with improved KPS score after treatment were 87.4%. There were 91 cases of fibrous type and epithelial type in WHO grade I, the benign rate was 95.8%. The central type (42 cases) and the anterior type (40 cases) are common growth sites, while the posterior type (13 cases) are relatively rare. There was a significant difference in the incidence of neurologic symptoms among the three types of paraspinal meningiomas, and the incidence of middle type was the highest. There was no statistical difference in the incidence of abnormal mental activity (P < 0. 369), there was significant difference in limb muscle strength or sensory abnormality (P < 0. 006), the incidence of middle type was the highest, and the incidence of visual impairment was significantly different (P < 0. 002), and that of posterior type was the highest. The total resection rate of the tumor was higher than that of the middle type (P < 0.048), the anterior type was 97.5) and the posterior type was 92.32.The total resection rate was lower than that of the middle type (81.0%). The incidence of neurologic complications was significantly higher than that of middle type, and the incidence of limb muscle strength and sensory abnormality was significantly higher than that of middle type. Conclusion: the surgical treatment of paraspinal meningioma is effective on the whole. The incidence of neurologic symptoms, especially limb muscle strength and sensory abnormalities, was higher, the total resection rate was lower than the other two types, and the incidence of postoperative neurologic complications was higher than that of the other two types. More caution should be exercised in the perioperative management and operation of this type of paraspinal meningioma.
【學(xué)位授予單位】：廣西醫(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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