可吸收人工脑膜预防窦镰旁大型脑膜瘤术后出血的临床分析

Clinical analysis on absorbable artificial dura mater for preventing postoperative hemorrhage in large parasagittal and falcine meningiomas

目的探讨可吸收人工脑膜预防窦镰旁大型脑膜瘤术后出血的临床应用价值。方法选取2011年9月至2014年11月重庆医科大学附属第一医院神经外科采用可吸收人工脑膜填塞窦镰旁大型脑膜瘤腔(肿瘤最大直径大于5 cm)预防术后出血的39例患者作为观察组;选取该院同期采用传统明胶海绵填塞窦镰旁大型脑膜瘤腔(肿瘤最大直径大于5 cm)预防术后出血的39例患者作为对照组。比较两组患者术后瘤腔坍塌程度、术后出血、颅内压变化、住院时间及术后随访功能恢复情况。结果观察组术后瘤腔坍塌程度[(21.00±6.20)%]、术后出血发生率[5.13%(2/39)]、术后颅内压[(14.97±4.58)mm Hg(1 mm Hg=0.133 k Pa)]、住院时间[(11.12±1.54)d]、术后随访功能状态(恢复良好37例)均显著优于对照组[(41.00±11.00)%、20.51%(8/39)、(16.97±6.62)mm Hg、(12.97±2.14)d、恢复良好31例],差异均有统计学意义(P<0.05)。结论可吸收人工脑膜与明胶海绵在填塞窦镰旁大型脑膜瘤腔时的作用相似,但在控制术后出血、缩短住院时间、提升预后等方面优于明胶海绵。

Objective To investigate the clinical application value of absorbable artificial dura mater in preventing postoperative hemorrhage in large parasagittal and falcine meningiomas. Methods A total of 39 patients with absorbable artificial dura mater for filling large parasagittal and falcine meningioma cavity（tumor maximal diameter 5 cm） and preventing postoperative hemorrhage in the neurosurgery department of the First Affiliated Hospital of Chongqing Medical University from September2011 to November 2014 were selected as the observation group;while the contemporaneous 39 patients with traditional gelatin sponge for filling large parasagittal and falcine meningioma cavity（tumor maximal diameter 5 cm） and preventing postoperative hemorrhage were selected as the control group. The degree of postoperative tumor cavity collapse,postoperative hemorrhage,intracranial pressure,hospital stay and postoperative follow-up functional recovery situation were compared between the two groups.Results The degree of postoperative tumor cavity collapse[（21.00±6.20）%],postoperative hemorrhage[5.13%（2/39）],intracranial pressure[（14.97±4.58）mm Hg（1 mm Hg=0.133 k Pa）],hospital stay[（11.12±1.54）d] and postoperative follow-up functional status（37 cases recovered well） in the observation group were obviously superior to the control group[（41.00±11.00）%,20.51%（8/39）,（16.97±6.62）mm Hg,（12.97±2.14）d,31 cases recovered well],the differences were statistically significant（P〈0.05）.Conclusion The absorbable artificial dura mater has the similar effect as gelatin sponge for preventing postoperative hemorrhage in large parasagittal and falcine meningiomas,but the former is superior to the latter in the aspects of controlling postoperative hemorrhage,shortening hospital duration and elevating the prognosis.