以颞叶囊性变为主的放射性脑病手术方式的探讨  

Discussion on the surgical methods of radiation-induced encephalopathy mainly featured with cystic change in the temporal lobe

作　　者：黄凯敏 谢琳[1] 欧阳乐平[1] 刘家豪[1] 黄佐於 何明亮[1] 刘安民[1] Huang Kaimin;Xie Lin;Ouyang Leping;Liu Jiahao;Huang Zuoyu;He Mingliang;Liu Anmin(Department of Neurosurgery, Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou 510120,China;Department of Neurosurgery,the Fifth Affiliated Hospital of Sun Yat-Sen University,Zhuhai 519000,China)

机构地区：[1]中山大学孙逸仙纪念医院神经外科,广州510120 [2]中山大学附属第五医院神经外科,珠海519000

出　　处：《中华神经外科杂志》2019年第12期1254-1257,共4页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81672507)。

摘　　要：目的探讨不同手术方式对以颞叶囊性变为主的放射性脑病的临床治疗效果。方法回顾性分析2010年1月至2016年12月中山大学孙逸仙纪念医院神经外科行手术治疗的56例以颞叶囊性变为主的放射性脑病患者的临床资料。其中,24例采用单纯病灶切除术(对照组);32例采用病灶切除及脑池解剖术(观察组)。根据患者的术后疗效、Karnofsky功能状态评分(KPS)、磁共振成像中病灶体积的大小及随访结果,比较两组患者的临床手术效果及预后。结果对照组中术后主诉症状完全缓解率为29.2%(7/24),观察组为71.9%(23/32),两组比较差异有统计学意义(P<0.05)。对照组术后的KPS为(70.13±19.10)分,观察组为(84.16±13.47)分,两组比较差异有统计学意义(P<0.05)。对照组术后的病灶体积为(32.35±20.85)cm^3,观察组为(13.31±6.44)cm^3,两组比较差异有统计学意义(P<0.05)。两组患者均随访1年,观察组的再次入院率低于对照组,分别为18.7%(6/32)、75.0%(18/24),两组比较差异有统计学意义(P<0.05)。结论对于以颞叶囊性为主的放射性脑病,手术方式除了单纯病灶切除之外,进一步解剖环池、脚间池,防止有占位效应的孤立囊腔形成,可达到更好的治疗效果。Objective To assess the clinical outcomes of various surgical methods of radiation-induced encephalopathy(REP)mainly featured with cystic change in the temporal lobe.Methods A retrospective study was conducted on the clinical data of 56 patients with REP mainly featured with cystic change in the temporal lobe who underwent surgery at Department of Neurosurgrey,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University from January 2010 to December 2016.Among them,24 peoples underwent merely lesionectomy(control group),while the other 32 peoples underwent lesionectomy and cistern opening(experimental group).According to the postoperative outcome,KPS(Karnofsky performance status)score,the volume of lesion on MRI and clinical follow-up,we compared the surgical effect between the 2 groups.Results In control group,7 patients(29.2%)reported relief of chief complaint,while 23 patients(71.9%)in experimental group had relief.The difference was statistically significant(P<0.05).The KPS score was 70.13±19.10 in control group and 84.16±13.47 in experimental group,which had significant difference(P<0.05).The volume of lesion post surgery was(32.35±20.85)cm^3 in group and(13.31±6.44)cm^3 in experimental group,which had statistical difference(P<0.05).The follow-up data showed that the readmission rate in experimental group(18.7%,6/32)was lower than that in control group(75.0%,18/24).which had significant difference(P<0.05).Conclusion For REP mainly featured with temporal lobe cyst,the surgical operation should include further dissection of cisterna ambiens and cisterna interpeduncularis in addition to merely lesionectomy,which could help prevent the formation of isolated cyst cavity with space-occupying effect and achieve better therapeutic results.

关 键 词：颞叶 放射性脑病 神经外科手术 治疗结果 

分 类 号：R73[医药卫生—肿瘤]