影响经手术治疗鞍区脑膜瘤视力预后的因素

Factors influencing the visual outcome in surgically treated meningiomas involving sellae region.

目的 分析影响经手术治疗鞍区脑膜瘤视力预后的因素。方法 收集以视力障碍为首发症状的鞍区脑膜瘤71例。先以双眼为单位,根据视力损伤评分表对其术后与术前的视力视野进行评分,以评分差来衡量预后并进行多重回归,筛选影响双眼视力预后的因素。再以单眼为单位,将术后视力以0 0 5为界分为2组,与其影响因素行单因素分析,再以0 .0 5、0 . 5和1 . 0为界分为4个等级,进行有序分类logistic回归,分析影响单眼术后视力的因素。结果 双眼视力的综合预后受其术前的评分及肿瘤切除程度的影响(B =- 0 . 1 0 9,P <0 . 0 5和B =7 4 .0 8,P <0 . 0 5) ;单眼的术后视力与其术前视力呈正相关(B =4 .2 55,P <0 .0 1 )与视乳头的病变程度及视神经的受累程度呈负相关(B =- 0 . 94 3,P <0 . 0 1和B =- 0 .830 ,P <0 . 0 5) ;术前视力低于0 .0 5、视乳头苍白萎缩或视神经管受累的眼球术后视力恢复到0 . 0 5以上的比例极小。结论 术前的视力、视乳头的病变程度、视神经的受累程度及肿瘤的切除程度对术后的视力恢复有影响。

Objective To analysis the factors influencing the visual outcome in surgically treated meningiomas involving sellae region. Methods 71 cases of meningiomas of sellae region were collected with the primary symptom of visual disturbance. Firstly, as far as both eyes were concerned, according to the visual impairment score, visual acuity and visual fields were assessed post-and pre-operatively,and the visual outcome was assessed by the difference of the score between post-and pre-operation. Multinomial regression was carried out to screen out the factors that influenced the visual outcome of both eyes. Then, as far as single eye was concerned, the postoperative visual acuity was divided into two groups by the number of 0.05, and one-way analysis was performed between postoperative visual acuity and its influencing factors. Further, the postoperative visual acuity was divided into four grades by the numbers of 0.05, 0.5 and 1.0, and ordinal categories logistic regression was carried out to analysis the factors that influenced the postoperative visual acuity of single eye. Results The visual outcome of the both eyes was influenced by the preoperative impairment score and extent of tumour removal ( B =-0.109, P <0.05 and B =7.408, P <0.05, respectively). The postoperative visual acuity of single eye showed a positive correlation to the preoperative visual acuity ( B =4.255, P <0.01) and a negative correlation to pathologyical change grades of optic papilla and involved degree of optic nerve ( B =-0.943, P <0.01 and B =-0.830, P <0.05, respectively). A little eye with preoperative visual acuity less than 0.05, a pale or atrophic optic papilla or an involved optic canal could achieve postoperative visual acuity more than 0.05. Conclusions The preoperative visual acuity, pathologyical change grades of optic papilla, involved degree of optic nerve and extent of tumour removal have some influence on the postoperative visual recovery.