听神经瘤手术脑脊液漏的相关因素分析

The related factors of cerebrospinal fluid leakage in acoustic neuroma surgery

目的探讨听神经瘤手术脑脊液漏的相关性因素。方法将2014年6月至2016年12月收治的90例听神经瘤患者,均采用枕下乙状窦后入路,在面神经监护下显微外科切除肿瘤,对比听神经瘤术后出现脑脊液漏的患者和未出现脑脊液漏的患者年龄、性别、病程、肿瘤大小、肿瘤的位置、肿瘤是否复发、术前是否内听道扩大、岩骨的气化程度、术中磨除内听道后壁、手术持续时间、合并糖尿病及体重指数(BMI)等因素,回顾性分析听神经瘤手术患者术后脑脊液漏的相关性因素。结果在考虑的众多因素中,只有术中磨除内听道后壁(OR:3.58,95%CI:1.022~12.536;P=0.046)、手术持续时间(OR:1.008,95%CI:1.001~1.016;P=0.029)及病程(OR:1.011,95%CI:1.001~1.023;P=0.040)具有统计学差异。结论听神经瘤手术脑脊液漏的相关因素包括术中磨除内听道后壁、手术持续时间及病程。

Objective The related factors of cerebrospinal fluid leakage in acoustic neuroma （vestibular schwannoma） surgery were investigated.Methods From June 2014 to December 2016,90 patients with acoustic neuroma were treated with surgical approach from sub-occipital sigmoid sinus.Microscopic resection of the tumor was performed under facial nerve monitoring.The data of patients with and without cerebrospinal fluid leakage after auditory neuropathy surgery were compared including age,sex,tumor size,location of the tumor,with/without recurrence of the tumor,with/without the internal auditory canal （IAC） expansion,the degree of gasification of the rock,intra-operative removal of the internal auditory canal wall,operative time,combined with diabetes and body mass index （BMI） and other factors,retrospectively.The related factors of cerebrospinal fluid leakage after acoustic neuroma surgery were analyzed.Results In these factors considered,only the intra-operative removing of the posterior wall of the auditory canal （OR：3.58,95％ CI：1.022 ～ 12.536;P =0.046）,the operative time （OR：1.008,95％CI：1.001 ～1.016;P =0.029） and the course of the disease （OR：1.011,95％ CI：1.001 ～1.023;P =0.040） were significantly different between the two groups.Conclusion The related factors of auditory cerebrospinal fluid leakage in acoustic neuroma include drilling of the posterior wall of the internal auditory canal,the operative time and the course of the disease.