经侧裂入路切除岛叶胶质瘤显微外科技术的应用及安全性研究

Application and safety of microsurgical technique for resection of insular glioma by lateral fissure approach

目的探讨经侧裂入路切除岛叶胶质瘤显微外科技术的应用并研究其安全性。方法 2015年3月至2016年11月北京大学深圳医院收治的岛叶胶质瘤病人38例,按入院单双日均分为观察组和对照组,观察组行经侧裂入路的岛叶胶质瘤显微切除术,对照组行传统岛叶肿瘤切除术,记录平均手术时间、术中平均出血量、肿瘤切除程度,术后记录病人恢复情况及并发症,比较两组病人的各项指标。结果观察组平均手术时间(4.0±0.5)h明显少于对照组(5.2±0.6)h(P<0.05),观察组术中平均出血量(372±62)mL显著低于对照组(528±89)mL(P<0.05);两组病人肿瘤均已切除,且病人都有不同程度上的恢复,但观察组病人肿瘤切除程度明显优于对照组(P<0.05),观察组病人术后恢复情况显著优于对照组(P<0.05);术后通过住院观察和随访,两组病人均有术后残腔出血、偏瘫、语言障碍的并发症发生,但对照组病人三种并发症发生概率均显著高于观察组(P<0.05)。结论经侧裂入路切除岛叶胶质瘤能较大程度上切除肿瘤,同时又减少术中出血、降低手术时间、改善病人术后恢复、减少并发症发生的优点,可作为岛叶胶质瘤显微外科治疗手术的首选。

Objective To understand the safety and efficacy of surgical excision of island leaf glioma performed by lateral approach.Methods From March 2015 to November 2016,38 patients with gliomas insula were divided into experimental group and control group.The experimental group patients were treated with lateral fissure approach of glioma surgery,while the control group with the traditional insula tumor excision surgery.The average operation time,intraoperative blood loss,degree of tumor resection,postoperative recovery and complications of the statistical differences of the two groups were compared.Results By lateral fissure approach in the insula group,average operation time glioma microsurgery is less than that of traditional insula tumor resection of the control group[(4.0±0.5)h vs.(5.2±0.6)h,P<0.05].The experimental group average intraoperative blood loss was significantly lower than the control group[(372±62)mL vs.(528±89)mL,P<0.05].Two groups of patients have tumor resection,with different degree of recovery,however,the experimental group patients with tumor resection was significantly better than the control group(P<0.05).The postoperative recovery of patients in treatment group was significantly better than that in the control group(P<0.05).Through observation and postoperative follow-up,two groups of patients had postoperative residual cavity bleeding complications,hemiplegia,the language barrier.However,the complication of incidence of the experimental group were significantly higher than that of the control group(P<0.05).Conclusion Lateral fissure approach in insula glioma tumor surgery to larger extent can decrease intraoperative bleeding,reduce the operation time,improve recovery,reduce the postoperative complications.The advantages of which make glioma surgery can be used as the first choice for insula operation.