鞍区脑膜瘤患者的临床特征及预后影响因素分析

Clinical characteristics and prognostic factors of sellar meningioma patients

目的探讨鞍区脑膜瘤患者的临床特征及预后影响因素分析。方法回顾性分析我院2009年11月~2015年12月收治的45例鞍区脑膜瘤患者,收集患者临床资料,分析鞍区脑膜瘤患者的临床特征。45例鞍区脑膜瘤患者出院后对其均进行相关随访,随访时间为4~59月,平均随访时间(21.09±10.64)月。采用Karnofsky功能状态量表对45例鞍区脑膜瘤患者进行生活质量评估,采用Logistic回归分析影响鞍区脑膜瘤患者术后生活质量的相关因素。结果45例鞍区脑膜瘤患者中,77.77%患者以视力障碍为主要临床症状,其中75.55%(34/45)的患者存在视野障碍,86.66%(39/45)患者同时存在视力障碍合并视野障碍,33例(73.33%)患者存在头痛现象,少数患者存在眼肌麻痹者、恶心、呕吐、性格改变、疲劳、嗜睡者、眼球突出;脑膜瘤中心位于鞍结节者较多(31.11%),48.88%(22/45)的患者病灶最大直径≤3cm。肿瘤全切除者共35例,其肿瘤全切除率(SimpsonⅠ~Ⅲ级)为77.77%,次切除率(SimpsonⅣ级)为22.22%;手术后出现1例(2.22%)患者死亡。入院时KPS评分、手术后视力恢复情况、肿瘤与垂体柄的关系、肿瘤生长方向、肿瘤与颈内动脉及其分支的关系、手术肿瘤切除程度是影响患者术后生活质量的单因素(P<0.05);整理患者术后生活质量的多因素Logistic回归分析结果得出:患者手术后视力恢复情况、肿瘤与垂体柄的关系、肿瘤与颈内动脉及其分支的关系、手术肿瘤切除程度是影响患者术后生活质量的独立危险因素(P<0.001)。结论鞍区脑膜瘤患者以视力障碍为主要临床特征,同时多伴有头痛症状。手术后视力恢复情况、肿瘤与垂体柄的关系、肿瘤与颈内动脉及其分支的关系、手术肿瘤切除程度是影响患者术后生活质量的独立危险因素。

Objective To investigate the clinical characteristics of patients with sellar meningiomas and the influencing factors of prognosis. Methods 45 patients with sellar meningiomas were retrospectively analyzed admitted in our hospital from November 2009 to December 2010. The clinical data of patients with sellar meningiomas were collected and analyzed. 45 patients with sellar meningioma were followed up for 4 to 59 months. The mean follow-up time was （21.09 ± 10.64） months. The Karnofsky functional status scale was used to evaluate the quality of life in 45 patients with sellar meningioma. Logistic regression was used to analyze the factors influencing the quality of life of patients with sellar meningiomas. Results Among 45 patients with saddle area meningioma, 77.77% （35/45） of them had vision disorder as the main clinical symptom. Among them, 75.55% （34/45） had visual field disorder, 86.66% （73.33%） patients had headache, a small number of patients had ophthalmoplegia, nausea, vomiting, personality changes, fatigue, lethargy, eyeballs. Meningioma center was located in the center of the eye. Saddle nodules were much, reaching 31.11% 48.88% （22/45） of the lesion diameter ≤ 3cm. The total resectable rate of tumor （Simpson Ⅰ -Ⅲ） was 77.77%. The resection rate （Simpson IV） was 22.22%. One patient （2.22%） died after operation. The results of univariate analysis showed that KPS score, visual acuity after operation, relationship between tumor and pituitary stalk, tumor growth direction, relationship between tumor and internal carotid artery and its branches and operation were influence factors （P 〈0.05）. Multivariate logistic regression analysis showed that the postoperative visual acuity of the patients was significantly higher than that of the pituitary stalk （P 〈0.05）. The postoperative quality of life was significantly correlated withthe postoperative quality of life. The relationship between the tumor and the internal carotid artery and its branch, and the degree of tumor resection is an independent risk factor influencing the quality of life of postoperative patients （P〈O. 001）. Conclusion Saddle area meningioma patients with visual impairment is the main clinical features, and more common in patients with headache symptoms. The postoperative visual acuity, the relationship between the tumor and the pituitary stalk, the relationship between the tumor and the internal carotid artery and its branches, and the degree of resection of the tumor are independent risk factors influencing the postoperative quality of life of the patients.