老年脑膜瘤患者开颅手术并发症90例分析

Ninety cases of postoperative complications in elderly patients after surgical removal of meningiomas

目的了解老年脑膜瘤开颅术后并发症发生的原因和危险因素。方法北京天坛医院1998至2007年共有320例老年（965岁）原发脑膜瘤患者接受开颅切除手术，90例（28．1％）出现术后并发症。其中男33例，女57例，年龄65—82岁，对该组患者进行了回顾性分析。结果本组患者均经病理证实为脑膜瘤，肿瘤直径平均5cm，平均手术时间4．8h。术后并发症包括新发神经功能功能障碍37例，术后昏迷16例，中枢神经系统感染14例，术后血肿10例，术后脑梗死7例，术后脑脊液漏12例，肺部感染18例，深静脉血栓或肺栓塞15例，消化道出血3例，心肌梗死2例，死亡共12例。术后并发症延长术后住院时间（平均23．7d）。结论老年脑膜瘤患者术后并发症较多，原因与肿瘤体积大，手术难度大，以及患者术前合并症多有关。

Objective To identify the causes and risk factors of postoperative complications in elderly patients receiving meningioma removal. Methods A total of 320 elderly patients received meningioma removal at our hospital between 1998 to 2007. Among them, 90 patients, aged 65 to 82 years old, developed postoperative complications. Results The diagnoses were confirmed by pathological findings. The average diameter of tumors was 5 cm. The average operative duration was 4. 8 hours. Local or systemic complications occurring in this group of patients included new-onset neurological deficit （ n = 37 ）, prolonged coma （n = 16）, central nervous system infection （n = 14） , postoperative hematoma （n = 10 ）, cerebral infarction （n = 7 ） , CSF leakage （n = 12） , pulmonary infection （n = 18 ）, deep vein thrombosis or pulmonary embolism （ n = 15 ）, gastrointestinal bleeding （ n = 3 ） and myocardial infarction （ n = 2 ）. Twelve patients died within 30 days after operation. Postoperative complications prolonged hospitalization and increased medical costs. Conclusion Large size of tumors, difficulties in resection and preexisting conditions are primary causes of a high rate of operative morbidity in elderly patients receiving meningioma removal.