大脑纵裂脑膜瘤显微术后并发症的影响因素分析

Influencing factors of postoperative complications of longitudinal fissure meningioma

目的探讨大脑纵裂脑膜瘤患者显微手术术后并发症的影响因素,以评估显微手术治疗的风险,降低术后并发症的发生率。方法回顾性分析2011年1月至2017年12月徐州医科大学神经外科经显微手术治疗的106例大脑纵裂脑膜瘤患者的临床资料。大脑纵裂脑膜瘤限定为肿瘤基底附着在大脑镰状窦、矢状窦以及大脑镰矢状窦都有附着的脑膜瘤。对比术后有并发症和无并发症患者的性别、年龄、主诉症状、肿瘤基底部位、肿瘤位置、肿瘤大小、肿瘤形状、MR增强程度、MR瘤周水肿、瘤周粘连中央沟静脉及引流静脉、肿瘤侵袭性、肿瘤边界、既往循环系统病史与术后是否存在并发症进行单因素分析,筛选术后出现并发症患者的影响因素,并对有统计学意义的因素进行二分类Logistic回归分析。结果瘤周中央沟静脉及引流静脉粘连是术后并发症的独立保护因素,瘤周无粘连患者术后并发症的风险仅为有粘连患者的0. 209倍。结论对于大脑纵裂脑膜瘤的患者,可以根据术前其瘤周中央沟静脉及引流静脉粘连情况较为客观地评估其术后并发症的风险。术中对待瘤周血管粘连明显的患者,要仔细保护中央沟静脉及引流等血管,才能显著降低患者术后并发症的发生率。

Objective To evaluate the risk of microsurgery and reduce the incidence of postoperative complications in patients with longitudinal fissure meningioma. Methods The clinical data of 106 patients with longitudinal fissure meningioma after microsurgery in the neurosurgery department of Xuzhou medical university from January 2011 to December 2017 were retrospectively analyzed. Longitudinal fissure meningioma were defined as the meningioma whose base were attached to the brain＇s sickle sinus,sagittal sinus and the brain＇s sickle sagittal sinus. Patients were divided into two groups according to whether there were postoperative complications. The gender,age,chief complaint symptoms,tumor base,tumor location,tumor size,tumor shape,MR enhancement,MR peritoneal edema,peritoneal adhesion of central sulcus vein and drainage vein,tumor invasiveness,tumor boundary,previous history of circulatory system were compared. Univariate analysis was performed on these factors to screen out the influencing factors of patients with postoperative complications. Binary logistic regression analysis was performed on the factors with statistical significance. Results Central sulcus vein and drainage vein adhesion were independent protective factors for postoperative complications. The risk of postoperative complications in patients without adhesion at peri-tumor stage was only 0. 209 times of that in patients with adhesion. Conclusion For patients with longitudinal fissure meningioma,preoperative risk of postoperative complications can be assessed objectively according to the condition of central sulcus vein and drainage vein adhesion around the tumor. In the treatment of patients with obvious peritumoral vascular adhesion,the central sulcus vein and drainage vessels should be carefully protected to significantly reduce the incidence of postoperative complications.