应用神经内镜技术治疗脑室内肿瘤的并发症及其危险因素分析

Complications and risk factors of neuroendoscopic treatment of intraventricular tumors

目的 探讨应用神经内镜技术治疗脑室内肿瘤的术后并发症及其相关危险因素.方法 回顾性分析首都医科大学附属北京天坛医院神经外科2004年2月至2016年7月采用神经内镜技术治疗的脑室内肿瘤患者的临床资料,共82例.所有患者均进行了2年及以上的随访,统计术后并发症的发生情况,分析影响并发症的相关危险因素.结果 82例患者均成功完成手术,无死亡患者.74例完成肿瘤切除,其中64例（78.1％）为全切除或次全切除,10例（12.2％）为大部分切除;8例（9.7％）仅行肿瘤活检术.术后共有25例（30.5％）发生并发症,其中颅内感染17例（20.7％）,脑室内出血5例（6.1％）,切口处皮下积液2例（2.4％）,神经功能损伤1例（1.2％）.74例切除肿瘤的患者中,术后2年肿瘤复发10例（13.5％）.多因素logistic回归分析显示,术前并发脑积水（OR=24.055,95％ CI：2.910-198.813,P=0.003）、肿瘤质地硬（OR=28.975,95％ CI：2.894～ 290.091,P=0.004）、肿瘤血供丰富（OR =43.118,95％ CI：2.134 ～871.302,P=0.014）是神经内镜治疗脑室内肿瘤术后并发症的独立危险因素.结论 采用神经内镜技术治疗脑室内肿瘤安全、有效,其中颅内感染是主要的并发症,术前合并脑积水、肿瘤质地硬及肿瘤血供丰富是影响术后并发症的独立危险因素.

 Objective To investigate the complications and risk factors of endoscopic treatment of intraventricular tumors.Methods A total of 82 cases of intraventricular tumors were enrolled into this study who underwent neuroendoscopic treatment at Neurosurgery Department,Beijing Tiantan Hospital,Capital Medical University from February 2004 to July 2016.All patients received complete follow-up lasting for over 2 years and their postoperative complications were documented.We analyzed the risk factors related to the patients＇ complications.Results All 82 patients underwent successful operations.There was no death.Total or subtotal resection was achieved in 64 （78.1%） patients,partial resection in 10 （12.2%）and tumor biopsy in 8 （9.7%）.Postoperative complications occurred in 25 （30.5%） patients and included intracranial infection in 17 （20.7%）,postoperative intraventricular hemorrhage in 5 （6.1%）,subcutaneous effusion in 2 （2.4%） and neurological impairment in 1 （1.2%）.Recurrence was reported in 10 （13.5%） cases 2 years post operation among 74 patients who underwent resection.Logistic regression analysis showed that preoperative hydrocephalus （OR =24.055,95% CI：2.910-198.813,P =0.003）,hard tumors （OR =28.975,95% CI：2.894-290.091,P =0.004） and blood vessel-rich tumors （OR =43.118,95% CI：2.134-871.302,P =0.014） were independent risk factors of postoperative complications.Conclusions Neuroendoscopic resection of intraventricular tumors is safe and effective.Intracranial infection seems to be the major complication.Preoperative hydrocephalus,hard tumors and blood vessel-rich tumors are independent risk factors for endoscopic treatment of intraventricular tumors.