显微镜下肿瘤切除术对脑胶质瘤患者临床疗效及预后的影响

Clinical Effect of Microsurgery on Prognosis of Glioma Patients

目的:探讨显微镜下肿瘤切除术与传统开颅切除术对脑胶质瘤临床效果及1年预后的影响。方法:收集2016年1月至2018年12月四川省大邑县人民医院神经外科收治的脑胶质瘤患者58例,按照治疗方式分为显微手术组(显微镜下肿瘤切除术,30例)与非显微手术组(传统开颅肿瘤切除术,28例),观察两组的手术相关指标、治疗效果以及术后1年的日常生活活动能力、认知功能及复发情况。结果:显微手术组治疗的总有效率为96.67%,明显高于非显微手术组78.57%,差异有统计学意义(P<0.05);显微手术组术后出现并发症2例(6.67%),低于非显微手术组6例(21.43%),但差异尚未显示有统计学意义(P>0.05)。与手术前相比,术后两组患者的简易智力状态检查量表(Mini-Mental State Examination,MMSE)、改良长谷川痴呆量表(Revised Hasegawa Dementia Scale,HDS-R)和日常生活活动能力量表(Activity of Daily Living,ADL)评分均分别较术前明显提升(均P<0.05);术后12个月时,显微手术组的MMSE、HDS-R和ADL评分均明显高于非显微手术组(均P<0.05)。显微手术组的手术时间、术中出血量、切口长度、术后下床时间及住院时间均较非显微手术组明显缩短(均P<0.05)。结论:显微镜下脑胶质瘤切手术临床疗效确切、手术安全可行,对患者造成的创伤小、术后并发症少,且患者认知功能及日常生活活动能力术后恢复较好。

Objective: To explore the influence of microsurgery and traditional craniotomy on the clinical effect and 1-year prognosis of glioma. Methods: A total of 58 patients with glioma from Department of Neurosurgery in our hospital from January 2016 to December 2018 were selected as research objects, and were assigned to the microsurgery group(tumor microscopic resection, 30 cases) and the non-microsurgery group(traditional craniotomy, 28 cases). Operation related indexes, treatment effect, daily activities 1 year after surgery, cognitive function and recurrence were retrospectively analyzed. Results: The total effective rate of the microsurgery group was 96.67%, significantly higher than that of the non-microsurgery group(78.57%)(P<0.05);postoperative complications were observed in 2 cases(6.67%) in the microsurgery group were, which was lower than that in the non microsurgery group [6 cases(21.43%)], the difference was not statistically significant however(P>0.05). Scores of Mini-Mental State Examination, Revised Hasegawa Dementia Scale and Activity of Daily Living significantly increased after surgery(P<0.05), and those scores in the microsurgery group were significantly higher than those in the non-microsurgery group 12 months after surgery(P<0.05). The operation time, intraoperative hemorrhage, incision length, time of getting out of bed and hospitalization in the microsurgery group were significantly shorter than those in the non-microsurgery group(P<0.05). Conclusion: Microsurgery for glioma is effective, safe and feasible, with little trauma to patients, fewer postoperative complications, and better postoperative recovery of cognitive function and daily activities.