儿童后颅窝肿瘤术后小脑性缄默综合征的临床特征及危险因素分析  

作　　者：杨伟 葛明[1] 黄凯坤 彭亚光[2] 张天蕾 冀园琦[1] 孙骇浪[1] 渠沛然 彭小娇 蔡英杰 Yang Wei;Ge Ming;Huang Kaikun;Peng Yaguang;Zhang Tianlei;Ji Yuanqi;Sun Hailang;Qu Peiran;Peng Xiaojiao;Cai Yingjie(Department of Neurosurgery,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Center for Clinical Epidemiology and Evidence Based Medicine,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院神经外科,100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院临床流行病与循证医学中心,100045

出　　处：《中华神经外科杂志》2020年第9期896-899,共4页Chinese Journal of Neurosurgery

基　　金：Clinical features and preoperative risk factors analysis of cerebellar mutism syndrome post surgery of posterior fossa tumor in children

摘　　要：目的探讨儿童后颅窝肿瘤术后小脑性缄默综合征(CMS)的临床特征及CMS相关的危险因素。方法回顾性分析2015年1月至2018年12月首都医科大学附属北京儿童医院神经外科收治的122例后颅窝肿瘤患儿的临床资料,根据患儿术后有无CMS,分为CMS组(31例)和非CMS组(91例)。观察CMS组患儿缄默的临床特点,比较两组间临床特征及术前影像学特征的差异。采用多因素logistic回归分析法判断影响术后CMS发生的危险因素。结果 122例患儿中,31例(25.4%)术后发生CMS。术后即刻发生CMS 19例,术后≤3 d出现CMS 11例,术后第7天出现CMS1例。至末次随访,除3例死亡患儿,其余28例患儿CMS持续时间为7~315 d,12例CMS持续时间为7~28 d,25例CMS持续时间≤90 d。CMS组与非CMS组比较,男性[分别为80.6%(25/31)、49.5%(45/91)]和髓母细胞瘤患者占比高[分别为71.0%(22/31)、37.4%(34/91)],差异均有统计学意义(均P<0.05);CMS组与非CMS组比较,实性肿瘤占比高[分别为92.9%(26/28)、67.5%(56/83)]、下蚓部受累多[分别为100.0%(28/28)、69.9%(58/83)]、脑干受压占比高[分别为85.7%(24/28)、61.4%(51/83)],比较两组肿瘤的位置差异有统计学意义(P<0.05);而两组间年龄、肿瘤直径、Evan′s指数、脑积水、室旁水肿及上蚓部受累者占比的差异均无统计学意义(均P>0.05)。多因素logistic回归分析显示,男性(OR=4.7,95%CI:1.5~14.1,P=0.006)、脑干受压(OR=4.7,95%CI:1.3~16.4,P=0.017)是影响后颅窝肿瘤患儿术后发生CMS的独立危险因素。结论 CMS多发生于术后早期,且多于3个月内恢复,男性、脑干受压可能是术后CMS发生的独立危险因素。Objective To investigate the clinical features of cerebellar mutism syndrome(CMS)and its related preoperative risk factors of CMS in children post surgery of posterior fossa tumor.Methods The clinical data of 122 children with posterior fossa tumors admitted to Department of Neurosurgery,Beijing Children's Hospital,Capital Medical University from January 2015 to December 2018 were retrospectively analyzed.They were divided into CMS group(n=31)and non-CMS group(n=91)according to whether CMS is present.The clinical characteristics of CMS were observed,and the clinical features and preoperative imaging features were compared between the two groups.Multivariate logistic regression analysis was used to determine the preoperative risk factors associated with postoperative CMS.Results Among all 122 cases,31(25.4%)developed CMS after operation.Mutism occurred immediately after operation in 19 cases,less than 3 days after operation in 11 cases,and in 1 case on the 7th day after operation.At the last follow-up,except for 3 deaths,the mutism duration in the other 28 cases was 7-315 clays.The CMS lasted for 7—28 days in 12 cases and less than 90 days in 25 cases.Compared with non-CMS group,the proportion of males in the CMS group was higher[80.6%(25/31)vs.49.5%(45/91)],and the proportion of medulloblastoma patients was higher[71.0%(22/31)vs.37.4%(34/91)],and the difference was statistically significant(both P<0.05).Compared with non-CMS group,the proportion of solid tumors in the CMS group was higher[92.9%(26/28)vs.67.5%(56/83)],the lower vermis was more involved 100.0%(28/28)vs.69.9%(58/83)],and the proportion of brainstem compression was higher[85.7%(24/28)vs.61.4%(51/83)].Those difference were all significant(all P<0.05).There was significant difference in the tumor location between the two groups(P<0.05).There was no significant difference in age,tumor size,Evan's index,hydrocephalus,paraventricular edema or the proportion of upper vermis involvement between the two groups(all P>0.05).Multivariate logistic regression a

关 键 词：运动不能性缄默症 脑肿瘤 颅窝 后 儿童 危险因素 

分 类 号：R739.41[医药卫生—肿瘤]