显微镜下全切或次全切术治疗脑胶质瘤的综合疗效及预后影响因素分析

Comprehensive clinical effect of total removal or subtotal resection under microscope of gliomas and prognosis influe ncing factors

目的探讨显微手术对脑胶质瘤的疗效及患者术后1年预后的影响因素。方法 2012年9月—2014年9月收治的80例脑胶质瘤患者按随机数字表法分为研究组和对照组各40例,研究组在显微镜下行全切或次全切术,对照组行常规开颅切除手术;比较2组患者手术前1 d、术后3个月、术后6个月认知功能（MMSE评分）和日常生活能力（ADL评分）,并检测脑脊液精氨酸加压素（AVP）、催产素（OT）、β-内啡肽（β-EP）、肿瘤坏死因子-α（TNF-α）水平。患者术后随访1年,分析患者性别、年龄、肿瘤分级、瘤体大小等一般资料与预后的关系。结果研究组术后1年MMSE评分明显高于对照组,ADL评分显著低于对照组（t=9.372、5.100,P〈0.05）;2组患者术后AVP、O1、β-EP、TNF-α水平均显著降低（P〈0.05）,其中术后3个月、6个月研究组AVP、OT、β-EP显著高于同时段对照组（P〈0.05）,而TNF-α水平比较差异无统计学意义（P〉0.05）。研究组术后偏瘫5例,失语症2例,并发症发生率为17.5%（7/40）;对照组偏瘫5例,失语症1例,感染3例,并发症发生率为22.5%（9/40）,2组患者术后并发症发生率比较差异无统计学意义（χ^20.781,P〉0.05）。多因素分析显示病理分级、肿瘤大小是脑胶质瘤预后的危险因素,术后放化疗是预后的保护因素（RR=1.094、1.387、0.513,P均〈0.05）。结论显微手术可改善脑胶质瘤患者认知、生活能力和提高神经肽水平;病理分级、肿瘤大小是脑胶质瘤预后的危险因素,术后放化疗是预后的保护因素。

Objective To investigate the effect of the surgical treatment for gliomas and the risk factors for 1 years after surgery prognosis. Methods From September 2012 to September 2014, 80 cases of brain glioma patients were enrolled, according to the random number table method, they were divided into study .group and control group, each group with 40 ca- ses, the study group underwent total resection and subtotal resection, and the control group received routine craniotomy, 1 d before surgery, 3 months, 6 months after surgery,the cognitive function （MMSE score） and activities of daily living （ADL） were compared between the two groups, and detected cerebrospinal fluid （CSF） and arginine vasopressin （AVP） and oxytoein （OT） , beta endorphin （β-EP） , tumor necrosis factor alpha （TNF-α） levels. The patients were followed up for 1 year, and the relationship between gender, age, tumor grade, tumor size, and prognosis was analyzed. Resalts After I year＇s MMSE score in study group was significantly higher than that of control group, ADL score was significantly lower than that of control group （ t = 9. 372, t = 5. 100, P 〈 0.05 ） ; two groups of patients＇ postoperative AVP, OT, beta EP, TNF-α level were sig- nificantly decreased （ P 〈 0.05 ）. The postoperative 3 months, 6 months＇ AVP, OT, β-EP in study group were significant higher than the same time＇ s control group （ P 〈 0.05 ）, and TNF-α level＇ s difference had no statistical significance （ P 〉 0.05）. After operation, study group had hemiplegia in 5 cases, 2 cases of aphasia, complication rate was 17.5% （7/40） ; control group had hemiplegia in 5 cases, 1 cases of aphasia, 3 cases of infection, complication rate was 22.5% （9/40）, two groups of patients＇ postoperative complication rate did not show statistically significant differences （χ^2 =0.781, P 〉0.05 ）. Multivariate analysis showed that pathological grading and tumor size are the risk factors of prognosis of gliomas, postoperative radiotherapy and chemotherapy are the protective factors for prognosis （RR = 1. 094, RR =1. 387, RR =0. 513, P 〈0.05）.Conclusion Surgical microscope in improving cerebral glioma patients cognition, life ability and level of the neuropeptide as- peers have a significant advantage; pathological grading and tumor size are risk factors for prognosis of glioma, postoperative radiotherapy and chemotherapy are the protective factor for prognosis.