乙状窦后入路与远外侧入路治疗岩斜区脑膜瘤疗效及对血清IGF-1、MCP-1水平和预后的影响

Efficacy of retrosigmoid approach and far lateral approach in the treatment of petroclival meningiomas and their influence on levels of serum IGF-I and MCP-1 and prognosis

目的:观察乙状窦后入路与远外侧入路治疗岩斜区脑膜瘤疗效及对血清IGF-I、MCP-1、CCL2水平和预后的影响。方法:回顾性分析2018年7月~2020年7月于我院就诊的132例岩斜区脑膜瘤患者,根据不同手术方式分为远外侧入路组(n=65)和乙状窦后入路组(n=67),比较两组肿瘤切除程度、并发症、术前、术后6个月神经功能及血清IGF-1水平、MCP-1水平及随访后预后情况。结果:术后,乙状窦后入路组肿瘤切除全切除率显著高于远外侧入路组;乙状窦后入路组术后并发症总发生率低于远外侧入路组;术后3个月,两组患者NIHSS评分较术前显著提高,IGF-1水平较术前显著降低,且两组术后3个月上述指标差异显著,两组患者MCP-1水平较术前降低,但均无显著差异;随访1年,乙状窦后入路组KPS评分≥80分比例显著高于远外侧入路组,乙状窦后入路组肿瘤复发率2.99%,未出现死亡病例,而远外侧入路组复发率和死亡率分别为10.77%和3.08%,两组比较差异均无显著差异。结论:通过乙状窦后入路对岩斜区脑膜瘤患者行切除术,全切除率高,能显著改善患者神经功能、血清IGF-1水平,提高患者生存质量,同时并发症少,值得临床推广。

Objective To observe the efficacy of retrosigmoid approach and far lateral approach in the treatment of petroclival meningiomas and their influence on levels of serum IGF-I,MCP-1 and CCL2 and prognosis.Methods A retrospective analysis was performed on 132 patients with petroclival meningiomas treated in the hospital between July 2018 and July 2020,and the patients were divided into far lateral approach group (n=65) and retrosigmoid approach group (n=67) according to different surgical methods.The tumor resection degree,complications,as well as neurological function and levels of serum IGF-1 and MCP-1 before surgery and at 6 months after surgery were compared between the two groups.Follow up was carried out in the two groups and the prognosis status was compared.Results After surgery,the total tumor resection rate of retrosigmoid approach group was significantly higher than that of far lateral approach group.The total incidence rate of postoperative complications was 2.99% in retrosigmoid approach group and was 7.69% in far lateral approach group.At 3 months after surgery,the NIHSS score of the two groups was significantly enhanced compared with that before surgery while the IGF-1 level was significantly reduced compared to before surgery,and the above indicators were significantly different between the two groups at 3 months after surgery.The MCP-1 level of the two groups was lower than that before surgery,but there was no significant difference between the groups.After 1 year of follow-up,the proportion of KPS score ≥80 points was significantly higher in retrosigmoid approach group than that in far lateral approach group.The tumor recurrence rate and death rate were 2.99% and 0 in retrosigmoid approach group,and were 10.77% and 3.08% in far lateral approach group.Conclusion Retrosigmoid approach for resection of petroclival meningiomas has a high total resection rate,and can significantly improve the neurological function and serum IGF-1 level and enhance the survival status.In addition,it has fewt complications,thus it is worthy of clinical promotion.