听神经瘤切除程度和术后并发症的影响因素  

Influencing factors of extent of resection and postoperative complications of vestibular schwannomas

作　　者：黄金海 吴鹏飞[1] 官彦雷 王明昊[1] 王文宣 王运杰[1] 欧绍武[1] HUANG Jinhai;WU Pengfei;GUAN Yanlei;WANG Minghao;WANG Wenxuan;WANG Yunjie;OU Shaowu(Department of Neurosurgery,The First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院神经外科,沈阳110001

出　　处：《中国医科大学学报》2023年第1期24-29,共6页Journal of China Medical University

基　　金：辽宁省教育厅科学研究经费项目(FWZR2020006)。

摘　　要：目的 分析听神经瘤切除程度和术后并发症的影响因素。方法 收集197例听神经瘤患者的临床资料,分析年龄、性别、肿瘤直径、肿瘤包绕血管、肿瘤与面神经粘连、肿瘤压迫脑干导致脑干水肿等因素与肿瘤切除程度、术后并发症的关系。结果197例患者均采用显微镜下乙状窦后入路进行手术治疗,肿瘤全切172例,次全切25例,全切率87.31%。术后出现新发并发症26例,无死亡病例。25例次全切患者中11例术后行伽马刀治疗,随访期间肿瘤无明显进展。术后KPS评分较术前明显升高(P=0.028)。全切组中肿瘤直径>3 cm的比例、肿瘤包绕血管的比例、肿瘤与面神经粘连的比例和肿瘤压迫脑干导致脑干水肿的比例均低于次全切组(均P <0.05),有术后并发症组中患者年龄>65岁的比例、肿瘤与面神经粘连的比例和肿瘤压迫脑干导致脑干水肿的比例均高于无术后并发症组(均P <0.05)。结论 肿瘤直径、肿瘤包绕血管、肿瘤与面神经粘连及肿瘤压迫脑干导致脑干水肿是听神经瘤切除程度的主要影响因素;年龄、肿瘤与面神经粘连及肿瘤压迫脑干导致脑干水肿是听神经瘤切除术后并发症的主要影响因素。Objective To explore the factors influencing extent of resection and postoperative complications of vestibular schwannomas.Methods This study collected the clinical data of 197 patients with vestibular schwannomas. The relationship between age,sex,diameter of tumors,vascularity,facial nerve adhesion,and brain stem edema,with the extent of resection and occurrence of postoperative complications was analyzed. Results All the 197 patients underwent surgery under microneurosurgery using the retrosigmoid approach. Surgeries included 172 total resections,and 25 subtotal resections. The total resection rate was 87.31%. Postoperative complications were found in 26 patients,and none of the patients died. Among 25 patients receiving subtotal resections,11 received radiotherapy after surgery,and no recurrence was found during the follow-up. The Karnofsky Performance Status(KPS) score significantly increased after surgery(P = 0.028).The proportions of patients with a tumor diameter >3 cm,surrounded by blood vessels,facial nerve adhesion,and brain stem edema in the total resection group was significantly lower than those in the subtotal resection group(all P < 0.05). Moreover,the proportions of patients aged >65 years,with facial nerve adhesion,and brain stem edema in the complication group was significantly higher than those in the non-complication group(all P < 0.05). Conclusion Tumor diameter,vascular encapsulation,facial nerve adhesion,and brain stem edema are major influencing factors of the extent of resection of vestibular schwannomas. Moreover,age,facial nerve adhesion,and brain stem edema are major influencing factors of postoperative complications.

关 键 词：听神经瘤 显微手术 切除程度 并发症 影响因素 

分 类 号：R651[医药卫生—外科学]