术前介入栓塞在大中型脑膜瘤手术治疗中应用

Application value of preoperative interventional embolization in the surgical treatment of large and medium-sized meningioma

目的探讨术前介入栓塞在大中型脑膜瘤手术治疗中的应用价值。方法选取自2016年1月至2019年1月广西壮族自治区民族医院收治的46例大中型脑膜瘤手术治疗患者为研究对象。根据栓塞材料的不同将患者分为A组(手术前使用聚乙烯醇颗粒介入栓塞,n=20)和B组(手术前使用明胶海绵介入栓塞,n=16),未进行介入栓塞而直接实施手术治疗者纳入C组(n=10),比较3组患者的手术效果。结果A组完全栓塞12例(60.0%),B组完全栓塞3例(18.8%),两组间比较,差异有统计学意义(P<0.05)。栓塞后,A组出现发热1例、短暂性头痛1例,B组出现发热1例,两组患者经对症治疗后症状消失或明显缓解,未发生颅内出血或偏瘫等并发症。与B组、C组比较,A组患者的手术时间较短,术中出血量减少,输血率明显降低,差异有统计学意义(P<0.05);B组患者的手术时间明显短于C组,术中出血量明显少于C组,输血率明显低于C组,差异有统计学意义(P<0.05)。3组患者的肿瘤全切率及治疗总费用比较,差异均无统计学意义(P>0.05)。部分栓塞患者Simpson分级Ⅰ级所占比例为66.7%(8/12),明显低于完全栓塞的100.0%(15/15)及大部分栓塞的87.5%(7/8),差异均有统计学意义(P<0.05)。结论大中型脑膜瘤手术治疗前行介入栓塞,可缩短患者的手术时间,减少术中出血量,疗效较佳。

Objective To investigate the value of preoperative interventional embolization in the surgical treatment of large and medium-sized meningioma.Methods A retrospective study was performed on 46 cases of patients with large and medium-sized meningioma who were admitted from January 2016 to January 2019.According to the different embolization materials,patients were divided into Group A(interventional embolization with polyvinyl alcohol particles before surgery,n=20)and Group B(interventional embolization with gelatin sponge before surgery,n=16)and those who underwent direct surgical treatment without interventional embolization were included into Group C(n=10).The surgical effects of the three groups were compared.Results There were 12 patients(60.0%)with complete embolization in Group A and 3 patients(18.8%)in Group B,and the difference between the two groups was statistically significant(P<0.05).There was 1 case of fever and 1 case of transient headache after embolization in Group A,and 1 case of fever in Group B.After symptomatic treatment,the symptoms of patients in the two groups disappeared or were significantly relieved,and no complications such as intracranial hemorrhage or hemiplegia occurred.Compared with Group B and Group C,patients in Group A had shorter surgery time,less intraoperative blood loss and significantly lower transfusion rate,with statistically significant differences(P<0.05).The operative time of patients in Group B was significantly shorter than that in Group C,the intraoperative blood loss was significantly less than that in Group C,and the transfusion rate was significantly lower than that in Group C(P<0.05).There was no significant difference in the total tumor resection rate and total treatment cost between the three groups(P>0.05).Part of embolism patients Simpson classⅠproportion was 66.7%(8/12),significantly lower than the complete embolization 100.0%(15/15)and 87.5%(7/8)of most embolism(P<0.05).Conclusion Interventional embolization before the surgical treatment of large and medium-sized meningioma can shorten the operation time of patients and reduce the amount of intraoperative blood loss,with better curative effect.