Koos3、4级听神经瘤术后面神经功能的影响因素分析  

Facial nerve function and influencing factors after excision of Koos grade 3 and 4 vestibular schwannomas

作　　者：任雪娇 王毅[1] 苏少波[1] 雪亮[1] 岳树源[1] 

机构地区：[1]天津医科大学总医院神经外科,300052

出　　处：《中华神经外科杂志》2018年第1期26-29,共4页Chinese Journal of Neurosurgery

基　　金：天津市应用基础与前沿技术研究计划（15JCQNJC11300）;天津市高等学校基本科研业务经费资助（2016YD02）

摘　　要：目的探讨影响Koos3、4级（大中型）听神经瘤术后面神经功能的相关因素。方法回顾性纳入2013年6月至2016年5月天津医科大学总医院神经外科收治的72例Koos3、4级听神经瘤的患者。术后随访1—2年，根据术后1年面神经功能House—Brackmann（H—B）分级标准分为A组（H-B分级I～Ⅱ级）和B组（H—B分级Ⅲ～Ⅵ级），评价其面神经功能，并分析其影响因素。结果72例患者中，术后1年面神经功能H—B分级Ⅰ～Ⅱ级（A组）53例，H—B分级Ⅲ～Ⅵ级（B组）19例，两组患者的肿瘤直径、囊变情况、面神经空间位置类型比较差异均有统计学意义（均P〈0．05）。Logistic多元回归分析表明：肿瘤直径（OR=2．538，95％CI：1．231～5．231；P=0．012）、肿瘤囊变（OR=6．209，95％CI：1．635～23．582；P=0．007）及面神经空间位置（3型对比1型：OR=6．103，95％CI：1．218—30．586；P=0．028）与Koos3、4级听神经瘤术后面神经功能相关（r=0．499，P〈0．05）；肿瘤直径相对较小、无囊变和面神经位于肿瘤前方（1型）者术后面神经功能恢复更好。结论肿瘤直径、囊性变及面神经空间位置类型是影响Koos3、4级（大中型）听神经瘤术后面神经功能的重要因素。精准的术前评估有益于面神经功能的保护与恢复。Objective To investigate the factors influencing facial nerve function after excision of Koos grade 3 and 4 vestibular schwannomas. Methods A retrospective analysis was conducted on 72 cases of Koos grade 3 and 4 vestibular schwannomas admitted to Department of Neurosurgery at General Hospital of Tianjin Medical University General from June 2013 to May 2016, which were followed up for 12 -48 months. According to the House-Brackmann classification of facial nerve function assessed at 1 year after operation, the patients were divided into two groups （Group A： H-B I-lI, Group B： H-B Ⅲ-Ⅳ） to evaluate the facial nerve function and analyzing the influencing factors. Results A total of 53 patients belonged to Group A and 19 cases were in Group B at 1 year after operation. The tumor size（OR =2.538,95%CI：1.231 - 5.231,P =0.012）, cysts（OR = 6. 209 ,95% CI ：1. 635 -23.582,P =0.007） and facial nerve displacement（type vs. type 1： OR =6. 103,95%CI： 1.218 - 30. 586, P = 0. 028 ） were significantly different （ all P 〈 0. 05 ） between the two groups. Multivariate logistic regression analysis showed that tumor size, cysts and facial nerve displacement were highly predictive factors for postoperative facial function （r =0.499,P 〈0.05）. Facial nerve function was better in cases with small tumors, non-cystic tufters and anterior facial nerve displa-cement （type 1）. Condusions Tumor size, cysts and facial nerve displacement are important factors that influence postoperative facial nerve function in cases of Koos grade 3 and 4 （large and medium-sized） vestibular schawannomas. Accurate preoperative assessment is beneficial to the protection and recovery of facial nerve function.

关 键 词：神经瘤 听 面神经 显微外科手术 影响因素分析 Koos分级 

分 类 号：R739.4[医药卫生—肿瘤]