神经内镜在脑胶质瘤手术中的初步应用效果分析  

Preliminary application effect of neuroendoscopy in glioma surgery

作　　者：钱增辉[1] 保肇实[1] 李一鸣[1] 李冠璋 赵大川 晋强[1] 张烁[3] 姚瑶 张伟[1] Qian Zenghui;Bao Zhaoshi;Li Yiming;Li Guanzhang;Zhao Dachuan;Jin Qiang;Zhang Shuo;Yao Yao;Zhang Wei(Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Operating Room,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科学中心,北京100070 [2]首都医科大学,北京市神经外科研究所,北京100070 [3]首都医科大学附属北京天坛医院手术室,北京100070

出　　处：《中华神经外科杂志》2025年第3期233-236,共4页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82001897);北京市卫生健康委员会研究型病房卓越临床研究计划(BRWEP2024W032040202)。

摘　　要：目的探讨应用神经内镜治疗脑胶质瘤的临床疗效。方法回顾性分析2023年6月至2024年8月首都医科大学附属北京天坛医院神经外科学中心应用神经内镜手术治疗的46例小脑幕上脑胶质瘤患者的临床资料。手术切口的长度为7 cm,骨瓣大小为3.5 cm×4.0 cm或4.0 cm×4.5 cm。根据肿瘤切除程度标准评估肿瘤的切除程度。记录患者的术后神经功能缺损、并发症的发生情况以及病死率。出院时以及术后1~3个月采用Karnofsky功能状态(KPS)评分评估患者的生命质量。结果46例患者均顺利完成手术,术后无一例出现颅内血肿。术中出血量为(168.7±60.2)ml(100~300 ml)。手术时长为(4.5±1.4)h(3.0~9.5 h)。肿瘤达到全切除34例(73.9%),近全切除9例(19.6%),次全切除3例(6.5%)。术后出现神经功能障碍患者6例,包括5例肢体活动障碍(其中3例伴有言语不利),1例意识障碍。出院时的KPS评分为(80.1±15.0)分(30~90分),所有患者均未出现其他并发症,无一例死亡。46例患者术后1~3个月随访时的KPS评分为(88.9±8.7)分(50~100分)。5例术后出现肢体活动障碍的患者均有不同程度的功能恢复。结论采用神经内镜手术治疗脑胶质瘤显示出较好的安全性和有效性,能够在创伤小的同时,保证较高的肿瘤切除率以及对并发症的良好控制。ObjectiveTo explore the clinical efficacy of neuroendoscopy in the treatment of gliomas.MethodsA retrospective analysis was conducted on the clinical data of 46 patients with gliomas who underwent neuroendoscopic surgery at the Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University from June 2023 to August 2024.The length of the surgical incision was 7 cm,and the size of the bone flap was 3.5 cm×4.0 cm or 4.0 cm×4.5 cm.The extent of tumor resection was evaluated based on the criteria for tumor resection.The postoperative neurological deficits,incidence of complications,and mortality rate were documented.The Karnofsky Performance Status(KPS)score was used to assess the life quality of patients at discharge and at 1 to 3 months post operation.ResultsAll 46 patients successfully completed the surgery,and no postoperative intracranial hematoma occurred.The intraoperative bleeding volume was 100-300 ml,with an average of 168.7±60.2 ml.The operation time was 3.0-9.5 h,with an average of 4.5±1.4 h.Total resection was achieved in 34 patients(73.9%),near-total resection in 9 patients(19.6%),and subtotal resection in 3 patients(6.5%).There were 6 patients with neurological dysfunction after surgery,including 5 cases of limb movement disorders(including 3 cases with speech impairment)and 1 case of consciousness disorder.At discharge,the KPS score ranged from 30 to 90 points,with an average of 80.1±15.0 points.None of the patients experienced new complications or death.During the 1-3 month follow-up after surgery,the KPS score ranged from 50 to 100 points,with an average of 88.9±8.7 points.Five patients who experienced limb dysfunction after surgery had varying degrees of functional recovery.ConclusionsThe use of neuroendoscopy to treat brain gliomas has shown good safety and effectiveness.It can ensure a high tumor resection rate and good control of complications with minimal trauma.

关 键 词：神经胶质瘤 神经外科手术 治疗结果 神经内镜 手术后并发症 

分 类 号：R651.1[医药卫生—外科学] R739.41[医药卫生—临床医学]