桥小脑角区表皮样囊肿不良预后的危险因素分析

Analysis on risk factors for poor prognosis of epidermoid cyst in cerebellopontine angle area

目的探讨影响桥小脑角区(CPA)表皮样囊肿预后的相关危险因素,以指导改进桥小脑角区表皮样囊肿的治疗,改善预后。方法回顾性分析23例桥小脑角区表皮样囊肿患者的临床资料。观察分析患者手术效果及术后恢复情况,根据患者的术后恢复及出院后的随访情况将其分为预后良好组(15例)和预后不良组(8例)。比较两组患者的基本资料、手术方式及预后,并对相关因素进行单因素及多因素分析。结果两组患者的年龄、是否为复发病例、肿瘤最大径、肿瘤是否越过中线、手术方式及术中出血量的差异具有统计学意义(P<0.05~0.01)。其中肿瘤最大径和手术方式为影响预后的独立危险因素(均P<0.05)。而性别、病程、术前是否有颅神经损害、是否合并其他慢性病、切除程度及是否放置引流的差异则均无统计学意义(均P>0.05)。单纯显微镜与神经内镜辅助显微镜手术患者的术中出血量、术后颅神经损害、术后住院天数的差异有统计学意义(P<0.05~0.001),而肿瘤切除程度、术后发热、术前症状是否缓解的差异则无统计学意义(均P>0.05)。结论除了降低年龄、病程、肿瘤体积等危险因素的影响外,手术方式的选择也是改善桥小脑角表皮样囊肿预后的关键因素。神经内镜辅助显微镜手术的应用能够减少术中损伤和术后并发症,提高病变切除程度,缩短患者手术后住院的时间。

Objective To explore the related risk factors affecting the prognosis of epidermoid cyst in cerebellopontine angle area(CPA),so as to guide the improvement of the treatment and prognosis of epidermoid cyst in CPA.Methods The clinical data of 23 patients with cerebellar angle epidermoid cyst were analyzed retrospectively.According to the postoperative recovery and follow-up after discharge,the patients were divided into good prognosis group(15 cases)and poor prognosis group(8 cases).The basic data,surgical methods and prognosis of the two groups were compared,and the related factors were analyzed by univariate and multivariate analysis.Results There were significant differences between the two groups in age,recurrence,maximum tumor diameter,whether the tumor crossed the midline,operation method and intraoperative bleeding(P<0.05-0.01).The maximum tumor diameter and operation mode were independent risk factors affecting the prognosis(all P<0.05).There was no significant difference in gender,course of disease,whether there was cranial nerve damage before operation,whether combined with other chronic diseases,degree of resection and whether drainage was placed(all P>0.05).There were significant differences in intraoperative bleeding,postoperative cranial nerve damage and postoperative hospital stay between patients with simple microscope and patients with neuroendoscope assisted microscope(P<0.05-0.001),but there were no statistical differences in the degree of tumor resection,postoperative fever and preoperative symptom relief(all P>0.05).Conclusions In addition to reducing the influence of risk factors such as age,course of disease and tumor volume,the choice of surgical method is also a key factor to improve the prognosis of epidermoid cyst in CPA.The application of endoscope assisted microsurgery can reduce intraoperative injury and postoperative complications,improve the degree of lesion resection,and shorten the hospital stay.