原发性颅内肿瘤临床分布及术后并发症危险因素

Clinical distribution of primary intracranial tumors and risk factors for postoperative complications

目的观察原发性颅内肿瘤的临床分布,并分析术后并发症发生的危险因素。方法对2018年1月至2022年12月在北京市天坛医院神经外科就诊的961例原发性颅内肿瘤患者临床资料进行回顾性分析。观察原发性颅内肿瘤患者的临床分布,统计术后并发症发生率。比较术后出现并发症和未出现并发症患者的基本资料,分析导致术后并发症发生的危险因素。结果961例患者中胶质瘤363例,脑(脊)膜瘤231例,鞍区肿瘤158例,神经鞘瘤142例,其他类型肿瘤67例。肿瘤部位:幕上肿瘤679例,幕下肿瘤282例。279例患者在术后出现各类并发症,发生率29.03%。其中颅内感染、肺部感染、低钠血症、下肢静脉血栓和中枢神经系统感染的发生率较高,发生率分别为9.37%、5.41%、4.99%、4.47%、4.27%。手术后,患者的D-二聚体(D-dimer,D-D)、纤维蛋白降解产物(fibrin degradation products,FPD)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activation of partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)水平均明显高于手术前,纤维蛋白原(fibrinogen,FIB)水平明显低于手术前,差异均具有统计学意义(均P<0.05)。术后出现并发症和未出现并发症的患者在肿瘤部位、术中出血量、手术时间、麻醉苏醒时间和术后凝血功能上存在统计学差异(P<0.05)。结论原发性颅内肿瘤的常见类型包括胶质瘤、脑(脊)膜瘤,鞍区肿瘤,神经鞘瘤等。手术治疗发生术后并发症的风险较高,常见的术后并发症包括颅内感染、肺部感染、低钠血症、下肢静脉血栓和中枢神经系统感染等。肿瘤部位、手术时长、术中出血量、麻醉苏醒时间和术后凝血功能异常均是导致术后并发症发生的危险因素。

Objective To examine the clinical distribution of primary intracranial tumors and analyze the risk factors for postoperative complications.Methods From January 2018 to December 2022,the clinical data of 961 patients with primary intracranial tumor in the Department of Neurosurgery of Tiantan Hospital in Beijing were collected and analyzed retrospectively.To examine the clinical distribution of patients with primary intracranial tumor and present the incidence of postoperative complications.To compare the basic data of patients with and without postoperative complications,and analyze the risk factors leading to postoperative complications.Results There were 363 cases of glioma,231 cases of meningioma,158 cases of sellar tumors,142 cases of neurilemmoma and 67 cases of other types of tumors.There were 679 cases of supratentorial tumors and 282 cases of infratentorial tumors.Postoperative complications occurred in 279 patients,and the incidence of postoperative complications was 29.03%.The incidences of intracranial infection,pulmonary infection,hyponatremia,lower extremity venous thrombosis and central nervous system infection were 9.37%,5.41%,4.99%,4.47%and 4.27%,respectively.After surgery,D-dimer(D-D),fibrin degradation products(FPD),prothrombin time(PT)in patients with primary intracranial tumors were significantly higher than those in patients without primary intracranial tumors(P<0.05).Activation of partial thromboplastin time(APTT),and thrombin time(TT)levels were significantly higher than those before surgery(P<0.05).Fibrinogen(FIB)was significantly lower than that before surgery(P<0.05).There were significant differences in tumor location,intraoperative blood loss,operation time,anesthesia recovery time and postoperative coagulation function between patients with and without postoperative complications(P<0.05).Conclusions The common types of primary intracranial tumors include gliomas,meningiomas,sellar tumors and neurilemmoma,etc.Surgical treatment has a high risk of postoperative complications.Common postoperative complications include intracranial infection,pulmonary infection,hyponatremia,lower extremity venous thrombosis,and central nervous system infection.Tumor location,operation duration,intraoperative blood loss,anesthesia recovery time and postoperative coagulation dysfunction are all risk factors for postoperative complications.