超声外科吸引器在矢状窦、大脑镰旁大脑膜瘤切除术的应用

Application of CUSA in large meningioma resection beside the sagittal sinus and cerebral falx

目的：探讨超声外科吸引器（cavitron ultrasonic surgical aspirator,CUSA）在矢状窦、大脑镰旁脑膜瘤切除术中的应用及临床意义。方法：回顾性分析51例矢状窦、大脑镰旁脑膜瘤病历资料,根据是否应用CUSA分成A、B两组,A组27例运用CUSA结合双极电凝行矢状窦、大脑镰旁脑膜瘤切除,B组24例组织剪结合双极电凝常规肿瘤切除。比较两组肿瘤切除率、手术时间、术中出血量、术后颅内压（intracranial pressure,ICP）、住院时间、甘露醇剂量、迟发性脑出血例数的统计学差异,并评估分析。结果：Simpson切除标准Ⅰ、Ⅱ、Ⅲ级A组分别为23、3、1例,B组为15、5、4例,两组切除率无统计学差异（P=0.125）;A组平均住院时间（15.11±2.50）d,B组（19.71±4.79）d,组间有统计学意义（P=0.019）;在出血量、手术时间上,A组分别为（631.48±240.65）ml、（4.27±0.27）h,B组为（1050.00±521.70）ml、（4.86±0.54）h,差异均有统计学意义（P=0.006,P=0.029）;ICP方面,6 h内两组差异不明显（P=0.138）;6~72 h及72 h后A组分别为（11.30±3.81 mm Hg、12.59±5.52 mm Hg）,B组为（13.96±9.95 mm Hg、16.83±8.98 mm Hg）,具有统计学差异（P=0.011、P=0.031）。其中A组1例发生急性肾功能衰竭,无迟发性脑出血;B组4例发生急性肾功能衰竭,迟发性脑出血5例,3例行开颅血肿清除术。3个月随访,A组恢复良好24例,恢复较差3例,无病重及死亡病例,组间有统计学差异（P=0.022）。结论：在矢状窦、大脑镰旁脑膜瘤切除术中,虽不能提高肿瘤切除率,但CUSA仍是一种实用而且有效的技术,能缩短手术时间、降低术后并发症,提高手术疗效,预后更佳。

Objective：To discuss the clinical significance and application of cavitron ultrasonic surgical aspirator（CUSA）in meningioma beside the sagittal sinus and falx cerebri resection. Methods：Fifty-one cases of meningioma beside the sagittal sinus and falx cerebri in our hospital were divided into A,B groups depending on the application of CUSA by retrospective analysis. Twenty-seven cases using CUSA with bipolar electric coagulation resection were enrolled in A group,24 cases using tissue scissors with bipolar coagulation conventional resection were enrolled in B group. Tumor resection rate,operative time,blood loss,postoperative intracranial pressure（ICP）,average hospitalization time,mannitol dose,delayed cerebral hemorrhage were compared between two groups. Results：Based on Simpson standard Ⅰ,Ⅱ,Ⅲ（grade）,there were 23,3,1（case）in group A while 15,5,4 in group B;there was no difference in removal rate between two groups（P=0.125）. The average hospitalization time of group A and group B was（15.11 ±2.50）d and（19.71±4.79）d,respectively,with statistically significant differences between groups A and B（P=0.019）. The operative time was（4.27±0.27）h and（4.86±0.54）h,respectively. The blood was（631.48±240.65）ml and（1050.00±521.70）ml,respectively,with statistically significant differences between groups A and B（P=0.006,P=0.029）. There was no significant difference in ICP within 6 h between two groups（P=0.138）. The ICP was（11.30±3.81）mm Hg and（12.59±5.52）mm Hg in group A within 6-72 h and at 72 h after operation;the ICP was（13.96±9.95） mm Hg and（16.83±8.98）mm Hg in group B within 6-72 h and at 72 h after operation,with statistically significant differences between groups A and B（P=0.011,P=0.031）. One case of acute renal failure and no case of delayed cerebral hemorrhage were observed in group A. Four cases of acute renal failure and five cases of delayed cerebral hemorrhage were observed in group B,among which three cases underwent removal of hematoma craniotomy. In 3-month follow-up,24 cases recovered well and 3 cases recovered poorly in group A. No death case and serious case was observed. Conclusion：In meningioma beside the sagittal sinus and falx cerebri resection,although we can not increase the rate of tumor resection,CUSA is still a practical and effective technology that can shorten the operation time,reduce complications,improve surgical outcome and prognosis.