影响鞍区脑膜瘤患者术后视力的相关因素分析  

Correlation factor analysis of affecting postoperative visual acuity in patients with sellar meningiomas

作　　者：张祎年[1] 黄文彪[3] 李峤[1] 李强[1] 牛亮[1] 代军强[1] 刘光耀[2] 潘亚文[1] 

机构地区：[1]兰州大学第二医院神经外科,兰州730030 [2]兰州大学第二医院磁共振科,兰州730030 [3]昆明市第一人民医院神经外科

出　　处：《中华神经外科杂志》2015年第11期1112-1117,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（81501116）;教育部高等学校博士学科点专项科研基金（20130211120026）;甘肃省卫生行业科研计划管理项目（GWGL2013-31）

摘　　要：目的总结鞍区脑膜瘤的临床特征、影像学特征、显微手术入路的选择，并探讨影响患者术后视力恢复的因素。方法回顾性分析44例鞍区脑膜瘤患者的临床资料并对其进行随访研究，总结鞍区脑膜瘤的临床特征、影像学特征、显微手术入路的选择。分别对可能影响患者术后视力恢复的因素进行非参数检验单因素分析和Logistic回归多因素分析。结果经单因素分析，影响术后视力恢复的因素有：术前视力障碍持续时间（P=0．001）、术前视力障碍程度（P=0．001）、术前眼底改变（P=0．001）、术前视觉诱发电位波幅改变（P=0．001）、肿瘤基底（P=0．006）、肿瘤质地（P=0．002）、肿瘤生长方向（P=0．003）、肿瘤与视神经的关系（P=0．001）、术中视神经的形态（P=0．001）、肿瘤与颈内动脉及其分支的关系（P=0．038）。经多因素Logistic回归分析发现，术前视力障碍程度（P=0．001）、术前眼底改变（P=0．019）、术前视觉诱发电位波幅改变（P=0．009）以及肿瘤与视神经的的关系（P=0．012）是影响术后视力恢复的显著因素。结论鞍区脑膜瘤应早期诊断、早期治疗，术前视力障碍程度、术前眼底改变、术前视觉诱发电位波幅改变以及肿瘤与视神经的的关系是影响术后视力恢复的重要因素。Objectives To summarize the clinical features, imaging features and the selection of microscopic surgical approaches and to investigate the factors of affecting postoperative visual acuity recovery of patients. Methods The clinical data of 44 patients with sellar meningiomas were analyzed retrospectively and the follow-up study was performed. The clinical features, imaging features, and selection of microsurgical approach were summarized. The factors that might affect the recovery of visual acuity in patients after procedure were analyzed respectively with the univariate analysis of non-parametric tests and logistic regression multivariate analysis. Results After univariate analysis, the factors of affecting visual acuity are as follows： duration of preoperative visual impairment （P = 0. 001 ） , degree of preoperative visual impairment （P = 0. 001 ）, preoperative fundus change （ P = 0. 001 ）, preoperative visual evoked potential amplitude change （ P = 0. 001 ）, tumor base （ P = 0. 006 ）, tumor texture （ P = 0. 002 ）, tumor growth direction （ P = 0. 003 ）, relationship between tumors and optic nerves （ P = 0. 001 ） , optic nerve morphology in surgery （ P = 0. 001 ）, and relationship between tumors and internal carotid artery and its branches （ P = 0. 038）. Multivariate logistic regression analysis found that the degree of preoperative visual impairment （P = 0. 001 ）, preoperative fundus change （ P = 0. 019 ）, preoperative visual evoked potential amplitude change （P =0. 009）, and relationship between tumors and optic nerves （P = 0. 012） were the significant factors for affecting postoperative visual acuity recovery. Conclusions Sellar meningiomas should be diagnosed and treated early. The degree of preoperative visual impairment, preoperative fundus change, preoperative visual evoked potential amplitude change and relationship between tumors and optic nerves are the key factors for affecting postoperative visual acuity recovery.

关 键 词：脑膜瘤 鞍区 视力 预后 

分 类 号：R739.45[医药卫生—肿瘤]