前床突脑膜瘤术后并发症的分析与防治

Analysis and prevention of postoperative complications of anterior clinoid meningioma

目的探讨前床突脑膜瘤(ACM)手术并发症的防治策略。方法回顾性分析自1999年7月至2021年6月经笔者治疗的63例ACM患者的临床资料。在Al-Mefty分型标准的基础上将ACM分为4型。根据术前影像学检查,Ⅰ型肿瘤7例(11.1%),Ⅱ型肿瘤39例(61.9%),Ⅲ型肿瘤5例(7.9%),Ⅳ型12例(19.0%)。根据术前肿瘤分型采取相应的措施防治并发症,分析影响术后并发症的主要因素。结果术后25例患者出现不同程度的并发症,其中13例较严重。主要并发症有视力恶化5例(7.94%),术后早期动眼神经麻痹3例(4.76%),术后轻偏瘫4例(6.35%),术后颅内感染1例(1.59%)。术后主要并发症总发生率为20.63%(13/63),术后永久性并发症发生率为6.35%(4/63)。无死亡病例。单因素分析结果显示,肿瘤的类型、大小、肿瘤与血管的关系分级和累及海绵窦是术后并发症的影响因素。结论ACM的全切除应采取积极谨慎的态度。依据不同类型的肿瘤特点制定详细的手术计划,术中采用合适的手术技巧,是减少手术并发症、改善整体预后的保障。

Objective To explore the prevention and treatment of surgical complications of anterior clinoid meningioma(ACM).Methods The clinical data of 63 patients with ACM treated by Chen Lihua from July 1999 to June 2021 were analyzed retrospectively.On the basis of Al-Mefty classification standard,ACM was divided into 4 types.According to the preoperative imaging examination,there were 7 cases(11.1%)of typeⅠtumors,39 cases(61.9%)of typeⅡtumors,5 cases(7.9%)of typeⅢtumors and 12 cases(19.0%)of typeⅣtumors.According to the preoperative tumor classification,corresponding measures were taken to prevent and treat complications,and the main factors affecting postoperative complications were analyzed.Results Twenty-five patients had different degrees of complications after surgery,iof which 13 were more serious.The main complications were vision deterioration in 5 cases(7.94%),early oculomotor paralysis in 3 cases(4.76%),light hemiparesis in 4 cases(6.35%)and intracranial infection in 1 case(1.59%).The total incidence of major complications after surgery was 20.6%(13/63),and 6.35%(4/63)for permanent complications.There were no deaths.The univariate analysis showed that the type of tumor,the size of the tumor,the grade of the relationship between tumor and vessels,and the involvement of the cavernous sinus were the main factors affecting postoperative complications.Conclusion The total resection of ACM should take a positive and cautious attitude.According to the characteristics of different types of ACM,making a detailed surgical plan and using appropriate surgical techniques during the operation are the guarantee of reducing surgical complications and improving the overall prognosis.