217例脑膜瘤术后生存质量分析

Analyses about Postoperative Quality of Life of the Patients with Meningiomas

目的 分析脑膜瘤患者术后影响生存质量的因素 ,为全面评估手术疗效提供依据。方法 回顾分析了近 10年住院行脑膜瘤切除术患者的临床资料、影像学检查、手术切除程度、组织学特征及术后转归 ,随访从 3个月～ 6 0个月 ,数据经计算机统计分析。结果 2 17例患者共行 2 4 3次开颅手术 ;良性 183例 (84 .3% ) ,非典型性 2 0例 (9.2 % ) ,恶性 14例 (6 .5 % ) ;术后 2 2例复发(10 .1% ) ;术前 4 7例、术后 31例癫痫发作 ;术后 4 4例并发神经功能缺失 ,其中偏瘫 34(15 .7% ) ,5例颅内出血均在术后死亡。结论 影响生存质量的主要因素包括术前癫痫发作、肿瘤大小、位置、形状、手术切除程度、组织学特征、术后偏瘫等并发症、肿瘤复发。加强和提高止血技能 ;提倡“不触及脑”原则 ;警惕瘤周静脉重要结构可减少癫痫发作发生率 ;术前影像分析、术中肿瘤范围识别 (多中心性、脑浸润性、骨侵蚀性 )及术后病理形态的观察。

Objective In order to provide reasonable evidence for evaluating the effectiveness of operation on the patients with meningiomas, to explore the pre-and post-operative quality of life(QOL).Methods A retrospective study in 217 meningioma cases were performed including their clinical data, radiological finds, the degree of excision, the histological features and outcome. The follow-up period ranged from 3 to 60 months.Results 217 patients underwent 243 craniotomies. 183 cases(84.3%) of benign, 20(9.2%) of atypical and 14(6.5%) of malignant were found. The postoperative recurrence occurred in 22 cases (10.1%). Preoperative seizures were documented in 47 patients but 31 cases suffered postoperative seizures. The main complication was deficit of neurological functions including 34 cases (15.7%) of hemiplegia and five cases of postoperative hemorrhage who all died.Conclusions The results indicated that preoperative epilepsy, the size,location,and shape of tumor, the degree of extirpation,histological findings,hemiplegia and recurrence were significantly related to quality of life. Therefore to increase the quality of life we must develop the technique of hemostasia, advocate the principle of 'non-touching' brain, watch out for peritumoral vein, study carefully radiological finds, the range of tumor, the histological feature, and follow-up with dynamic computer tomography.