经改良Poppen入路切除松果体区肿瘤患者预后影响因素分析

Prognostic factors of pineal region tumors resected by the modified Poppen approach

目的探讨影响经改良Poppen入路显微切除成人松果体区肿瘤患者预后的影响因素,以期发现导致患者预后不良的相关因素,改善患者临床预后。方法收集中国科学技术大学附属第一医院神经外科自2015年6月—2020年7月收治并行经改良Poppen入路显微切除成人松果体区肿瘤患者临床资料,回顾性分析上述资料。结果共纳入患者48例,患者于术后1个月行卡诺夫斯凯计分(KPS)评分,根据KPS评分结果将患者分为2组(以KPS评分70及以上为预后较好,KPS评分70分以下为预后较差,因KPS评分70分以下患者有效的抗肿瘤方案无法实施)。其中预后较好患者29例,预后较差患者19例。在2组患者的单因素分析比较中,预后较差组出血量[(466.84±182.18)mL]多于预后较好组[(364.14±123.42)mL]、预后较差组术后枕叶损伤发生率(57.89%,11/19)高于预后较好组(24.14%,7/29);多因素logistic回归分析结果提示患者术后KPS评分仅与患者术后出现枕叶损伤(OR=4.887)、病变与顶盖关系相关(OR=5.870),与术前患者KPS评分及术中出血量无关。结论研究显示改良Poppen入路进行脑肿瘤的显微外科切除能够改善患者预后,部分患者预后较差与患者肿瘤位置、术后枕叶是否损伤以及出血量多少有关。手术中应避免过度牵拉,降低枕叶损伤可能;对于肿瘤位于顶盖前方患者考虑更换手术方式;术中降低总出血量可能改善患者预后。

Objective To investigate the factors influencing the prognosis of adult pineal region tumors after microresection via the modified Poppen approach,so as to identify the related factors leading to poor prognosis and improve clinical prognosis of patients.Methods Clinical data of adult patients admitted to the Neurosurgery Department of the Provincial Hospital affiliated to the University of Science and Technology of China from June 2015 to July 2020 who underwent microresection of pineal region tumors via the modified Poppen approach were collected and retrospectively analyzed.Results A total of 48 patients were collected.The patients received Karnofsky performance score(KPS)index score 1 month after surgery,and were divided into two groups according to the results of KPS score.Those with a KPS score of 70 or above were considered to have a good prognosis,while those with a KPS score of 70 or below were considered to have a poor prognosis,because effective anti-tumor regimens could not be implemented for patients with a KPS score of 70 or below.There were 29 patients with good prognosis and 19 patients with poor prognosis.The results of univariate analysis showed that the amount of blood loss in the poor prognosis group[(466.84±182.18)mL]was higher than that in the good prognosis group[(364.14±123.42)mL].The incidence of postoperative occipital lobe injury in the poor prognosis group(57.89%,11/19)was higher than that in the good prognosis group(24.14%,7/29).However,the results of multivariate Logistic regression analysis showed that postoperative KPS score was only correlated with postoperative occipital lobe injury(OR=4.887)and the relationship between the lesion and the parietal capsule(OR=5.870),but not related to the preoperative KPS score and intraoperative blood loss.Conclusion Microresection of brain tumors using the modified Poppen approach can improve the prognosis of patients.The poor prognosis of some patients is related to tumor location,postoperative occipital lobe injury and the amount of blood loss.Excessive traction should be avoided in operation to reduce the possibility of occipital lobe injury.For patients whose tumors are located in front of the parietal cap,the surgical methods should be replaced.Intraoperative reduction of total blood loss may improve patient outcomes.