显微手术治疗脊髓室管膜瘤预后的影响因素分析

Analysis of risk factors related to prognosis in patients with spinal cord ependymoma undergoing microneurosurgery

目的探讨显微手术治疗脊髓室管膜瘤的疗效及影响预后的因素。方法对手术治疗的80例脊髓室管膜瘤的临床资料进行回顾性分析,参照欧洲脊髓病评分(EMS)和Mc Cormick分级评估手术前后脊髓功能;采用多因素Logistic回归分析检验预后影响因素。结果肿瘤全切除51例,次全切除25例,大部分切除4例。术后平均随访(37.6±19.0)个月,复发5例,均为WHOⅡ级,复发时间为(58.4±43.1)个月。末次随访有49例脊髓功能较术前改善,19例无变化,12例加重。术后Mc Cormick分级:Ⅰ级35例,Ⅱ级22例,Ⅲ级12例,Ⅳ级11例。多因素Logistic回归分析发现,术前存在大小便功能障碍是不良预后独立危险因素,而伴脊髓空洞是预后良好因素。末次随访EMS[(15.01±0.3)分]明显高于术前[(13.55±0.35)分;P<0.001]和术后3 d[(13.20±0.31)分;P<0.001]。结论脊髓室管膜瘤显微手术治疗后脊髓神经功能在短期内以趋于稳定为主,但从长远来看,显微手术能有效治疗脊髓室管膜瘤。存在大小便功能障碍的室管膜瘤建议及早手术治疗;伴有脊髓空洞的脊髓室管膜瘤手术预后良好。

Objective To investigate the risk factors related to the prognosis in the patients with spinal cord ependymomas undergoing microneurosurgery.Methods The clinical data of 80 patients with intramedullary ependymomas,who underwent surgery in our hospital from June,2007 to February,2017,were analyzed retrospectively.The factors related to prognosis were statistically analyzed.The spinal function was assessed before and after the surgery by European Myelopathy Scores(EMS).All the patients were followed up for(37.6±19.0)months.Results Of 80 patients with intramedullary ependynomas,51 received the total resection of the tumors,25 subtotal and 4 parts.Univariate analysis showed that the rates of preoperative fecal and uninary incontinences occurrence and preoperative syringomyelia occurrence were significantly lower in 49 patients with good outcomes than those in 31 patients with poor outcomes(P<0.05).Multivariate logistic regression analysis showed that the risk factors related to the prognosis included the preoperative fecal and uninary incontinences and syringomyelia in the patients with intramedullary ependynomas undergoing surgery(P<0.05).EMS of the spinal function were significantly higher at the last following up than those before the operation and 3 days after the operation(P<0.01).Conclusions The prognoses after the surgery are poor in the intramedullary patients with the preoperative fecal and uninary incontinences or syringomyelia.The spinal function tends to be stable during the postoperative short period and the long-term curative effects of the surgery are good in the patients with intramedullary ependynomas.