无症状脑膜瘤的临床特征及手术治疗  

Clinical Characteristics and Surgical Results for Patients with Asymptomatic Meningioma

作　　者：曾令成[1] 厉华 陈如东 杨洪宽 陈坚[1] 于加省 Zeng Lingcheng;Li Hua;Chen Rudong(Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《华中科技大学学报（医学版）》2023年第6期847-854,共8页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的总结无症状脑膜瘤患者的临床特征,评估与手术并发症及预后相关的因素,为筛选适宜行早期手术治疗的无症状脑膜瘤患者提供依据。方法回顾性收集2015年1月1日至2020年12月31日期间于华中科技大学同济医学院附属同济医院神经外科接受手术治疗的原发脑膜瘤患者的病历资料,比较有症状脑膜瘤及无症状脑膜瘤患者的临床特征,分析与无症状脑膜瘤手术效果、术后并发症及患者预后相关联的因素,并进一步行多因素Logistic二元回归分析验证。结果老龄(HR:2.042;95%CI:1.002~4.098;P=0.021)、肿瘤较小(HR:1.666;95%CI:1.009~3.857;P=0.014)、颅腔浅部分布(HR:2.221;95%CI:1.236~3.994;P=0.008)及无瘤周水肿(HR:8.917;95%CI:5.028~15.813;P<0.01)为无症状脑膜瘤区别于有症状脑膜瘤的显著特征。无症状脑膜瘤全切率(88.6%)显著高于有症状脑膜瘤(78.8%)(P=0.035),全切除的无症状脑膜瘤病例中有72%位于颅腔浅部,仅28%位于颅腔深部。顶部定位是与无症状脑膜瘤术后并发症显著相关因素(HR:3.351;95%CI:1.258~11.355;P=0.024)。92.0%的无症状脑膜瘤患者术后半年均能恢复正常的工作生活,老龄(≥60岁)为与无症状脑膜瘤患者预后不良的危险因素(HR:0.875;95%CI:0.825~0.999;P=0.041)。结论无症状脑膜瘤多见于老年患者,常位于颅腔浅部,肿瘤体积较小,通常不伴随瘤周水肿,手术全切除率更高。早期手术可作为无症状脑膜瘤恰当的治疗策略,患者肿瘤部位以及年龄为预测患者术后并发症及预后的潜在指标,术前需注意综合评估。Objective To summarize the clinical features of asymptomatic meningioma patients and evaluate the factors related to surgical complications and prognosis,and to provide evidence for screening asymptomatic meningioma patients suitable for early surgical intervention.Methods The medical records of meningioma patients who underwent surgery from January 1st 2015 to December 31st 2020 at Neurosurgery Department of Tongji Hospital Affiliated to Tongji Medical College were retrospectively reviewed.The clinical characteristics were compared between symptomatic and asymptomatic meningioma.Factors related to the effects of surgery,postsurgical complications or patient prognosis were analyzed through Chi-squared test and multivariate binary Logistic regression analysis.Results Elder age(HR:2.042;95%CI:1.002-4.098;P=0.021),smaller tumor size(HR:1.666;95%CI:1.009-3.857;P=0.014),intracranial superficial location(HR:2.221;95%CI:1.236-3.994;P=0.008)and no peritumoral brain edema(HR:8.917;95%CI:5.028-15.813;P<0.01)were significant features of asymptomatic meningioma compared to those of symptomatic ones.The benefit of early surgery for asymptomatic meningioma was the achievement of higher total resection rate(88.6%)(P=0.035).Among the total resection cases,72%located in the intracranial superficial area,while merely 28%located in the intracranial deep area.Ninety-two percent of asymptomatic patients had returned to normal work and life at 6 months after operation.A parietal location was a significant factor indicating postsurgical complications(HR:3.351;95%CI:1.258-11.355;P=0.024),while elder age(≥60 years old)(HR:0.875;95%CI:0.825-0.999;P=0.041)was a significant factor indicating poor patient prognosis.Conclusion Asymptomatic meningioma is more common in elderly patients,usually located superficially in cranial cavity,with smaller size and without peritumoral edema.A more prominent total resection rate can be achieved in this type of meningioma.An early surgical resection would be recommended as a proper treatment strategy.Tum

关 键 词：无症状脑膜瘤 临床特征 手术 预后 

分 类 号：R739.45[医药卫生—肿瘤]