Kawase's入路手术切除岩斜区脑膜瘤的临床研究

Clinical Study of Kawase's Approach for Resection of Petroclival Meningiomas

目的探究颞下经岩骨前入路(Kawase's入路)手术切除岩斜区脑膜瘤的临床效果。方法选取2014年1月～2017年1月笔者医院收治的岩斜区脑膜瘤患者56例为研究对象。患者均行显微外科手术治疗,根据手术入路方式不同将患者分为研究组(Kawase's入路组,27例)、对照组(颞下经小脑幕入路组,29例)。观察两组肿瘤切除情况、术前与术后6个月的神经功能缺损评分(NIHSS)及生活质量评分(KPS)、并发症发生情况。结果研究组肿瘤全切除率(62. 96%)高于对照组(58. 62%),次全切除率(33. 33%)、部分切除率(3. 70%)低于对照组(34. 48%、6. 90%),但差异无统计学意义(χ2=0. 111、0. 008、0. 281,P> 0. 05)。术前两组NIHSS、KPS评分差异无统计学意义(t=0. 439、0. 470,P> 0. 05);术后6个月两组NIHSS、KPS评分均显著改善,研究组NIHSS评分低于对照组(t=8. 694,P <0. 05),而KPS评分的组间比较差异无统计学意义(t=0. 456,P>0. 05)。研究组皮下积液发生率(0)、并发症总发生率(11. 11%)低于对照组(13. 79%、34. 48%)(χ2=4. 011、4. 285,P均<0. 05)。结论Kawase's入路手术切除岩斜区脑膜瘤可提高肿瘤切除率,降低并发症发生率,更有利于术后神经功能恢复及生活质量改善。

Objective To investigate the clinical effect of Kawase′s approach for excision of petroclival meningioma.Methods From January 2014 to January 2017,56 patients with lithotactic meningioma admitted to our hospital were enrolled in this study.Patients underwent microsurgical treatment.The patients were divided into study group(Kawase′s approach group,27 cases)and control group(TMOT,29 cases)according to the surgical approach.The tumor resection,neurological deficit score(NIHSS),quality of life score(KPS)and complications of the two groups were observed before and 6 months after operation.Results The total resection rate(62.96%)in the study group was significantly higher than that in the control group(58.62%),the subtotal resection rate was 33.33%and the partial resection rate was 3.70%lower than the control group(34.48%,6.90%),The difference was not statistically significant(χ2=0.111,0.008,0.281,P>0.05).There was no significant difference between the two groups in preoperative NIHSS and KPS scores(t=0.439,0.470,P>0.05).NIHSS and KPS scores of both groups were significantly improved at 6 months after operation,The NIHSS score of the study group was lower than that of the control group(t=8.694,P<0.05).There was no significant difference between KPS scores(t=0.456,P>0.05).The incidence of subcutaneous effusion(0)and complication rate(11.11%)in the study group was lower than that in the control group(13.79%,34.48%,χ2=4.011,4.285,P all<0.05).Conclusion Kawase′s approach for excision of petroclival meningiomas can improve tumor resection rate,reduce the incidence of complications,and more conducive to postoperative recovery of neurological function and quality of life.