扩大颅底入路与标准翼点入路治疗床突旁脑膜瘤患者的疗效比较

Comparison of the efficacy of extended skull base approach and standard pterional approach for the treatment of paraclinoidal meningiomas

目的探讨扩大颅底入路和标准翼点入路治疗床突旁脑膜瘤的疗效。方法分析河南省人民医院经手术治疗的床突旁脑膜瘤患者41例,按肿瘤大小随机分为标准翼点入路组(19例)和扩大颅底入路组(22例),比较两组在肿瘤全切、视功能改善、手术用时、术中失血量、颅神经损伤等围术期指标的差异。计量资料组间比较采用t检验;计数资料组间比较采用χ^(2)检验。结果标准翼点入路组与扩大颅底入路组的全切率分别为74%(14/19)和91%(20/22),两组差异有统计学意义(χ^(2)=11.638,P<0.05)。视功能改善率分别为65%(11/17)和79%(15/19),两组差异有统计学意义(χ^(2)=12.315,P<0.05)。手术用时分别为(201.50±23.17)分和(209.50±19.37)分,两组差异无统计学意义(t=6.777,P>0.05)。术中失血量分别为(134.20±12.37)ml和(159.60±22.47)ml,两组差异无统计学意义(t=6.352,P>0.05)。术后动眼神经麻痹发生率分别为11%(2/19)和9%(2/22),两组差异无统计学意义(χ^(2)=0.096,P>0.05)。结论扩大颅底入路可提高床突旁脑膜瘤患者的全切率和改善视觉功能。

Objective To investigate and compare the curative effectiveness of extended skull base approach and standard pterional approach in parasclinoidal meningiomas(PCMs).Methods Totally,41 patients undergoing surgery with PCMs admitted in Henan Province People’s Hospital were analyzed,and randomly divided into 2 groups according to tumor size:standard pterional approach group(19 cases)and extended skull base approach group(22 cases).The perioperative therapeutic effect was compared between two groups,including rate of gross total resection(GTR),rate of visual function improvement(VFI),operating duration,intraoperative blood loss,rate of cranial never injury.The measurement data were expressed as(mean±SD)and t-test was used for comparison between groups.The counting data were expressed in percentage(%),and the chi square test was used for component comparison.Results The rate of GTR in standard pterional approach group and extended skull base approach group was 74%and 91%respectively(χ^(2)=11.638,P<0.05).The rate of VFI in extended skull base approach group and standard pterional approach group was 65%and 79%respectively(χ^(2)=12.315,P<0.05).The time of operating duration in standard pterional approach group and extended skull base approach group was(201.50±23.17)min and(209.50±19.37)min respectively(t=6.777,P>0.05).The intraoperative blood loss in standard pterional approach group and extended skull base approach group was(134.20±12.37)ml and(159.60±22.47)ml respectively(t=6.352,P>0.05).The rate of postoperative oculomotor nerve palsy in standard pterional approach group and extended skull base approach group was 11%and 9%respectively(χ^(2)=0.096,P>0.05).Conclusion Extended skull base approach can enhance and improve the rate of GTR and visual function of patients with PCMs.