探讨采用经双侧额下入路与经额外侧入路显微手术治疗大型嗅沟脑膜瘤的临床效果

2019-08-18 08:06谢伟陈凡帆
中国实用医药 2019年19期

谢伟 陈凡帆

【摘要】 目的 观察在大型嗅沟脑膜瘤的治疗中采用经双侧额下入路与经额外侧入路显微手术治疗的临床疗效。方法 65例大型嗅沟脑膜瘤患者, 根据手术入路不同分为额下组31例, 采取双侧额下入路显微手术治疗)和外侧组34例, 采取经额外侧入路显微手术治疗)。比较两组患者症状改善、并发症发生情况及肿瘤切除效果。结果 额下组患者肿瘤切除Ⅰ级9例(29.03%)、Ⅱ级7例(22.58%)、Ⅲ级9例(29.03%)、Ⅳ级6例(19.35%);外侧组患者肿瘤切除Ⅰ级21例(61.76%)、Ⅱ级9例(26.47%)、Ⅲ级3例(8.82%)、Ⅳ级1例(2.94%)。外侧组患者肿瘤切除效果优于额下组, 差异具有统计学意义(U=3.051, P<0.05)。额下组患者精神改善率为74.19%, 低于外侧组的85.29%, 但差异无统计学意义(P>0.05)。额下组患者嗅觉改善率38.71%和视觉改善率41.94%均低于外侧组的67.65%、82.35%, 且并发症发生率22.58%高于外侧组的2.94%, 差异均具有统计学意义(P<0.05)。结论 在大型嗅沟脑膜瘤的治疗中, 采取经额外侧入路显微手术治疗, 可明显提高肿瘤切除效果, 改善症状, 减少并发症的发生。

【关键词】 双侧额下入路;经额外侧入路;显微手术;大型嗅沟脑膜瘤

DOI:10.14163/j.cnki.11-5547/r.2019.19.002

【Abstract】 Objective   To observe the clinical efficacy of bilateral subfrontal approach and additional lateral approach in microsurgery for large olfactory groove meningiomas. Methods   A total of 65 patients with large olfactory groove meningiomas were divided by different surgery approaches into subfrontal group (31 cases), treated by bilateral subfrontal approach) and lateral group (34 cases), treated by extra lateral approach). The symptom improvement, occurrence of complications and tumor resection effect in two groups was compared. Results   Subfrontal group had tumor resection grade Ⅰ in 9 cases (29.03%), grade Ⅱ in 7 cases (22.58%), grade Ⅲ in 9 cases (29.03%) and grade Ⅳ in 6 cases (19.35%).Lateral group had tumor resection grade Ⅰ in 21 cases (61.76%), grade Ⅱ in 9 cases (26.47%), grade Ⅲ in 3 cases(8.82%) and grade Ⅳ in 1 case (2.94%). Lateral group had better tumor resection effect than subfrontal group, and the difference was statistically significant (U=3.051, P<0.05). Subfrontal group had lower mental improvement rate as 74.19% than 85.29% in lateral group, but the difference was not statistically significant (P>0.05). Subfrontal group had lower olfactory improvement rate as 38.71% and visual improvement rate as 41.94% than 67.65% and 82.35% in lateral group, and higher incidence of complications as 22.58% than 2.94% in lateral group. Their difference was statistically significant (P<0.05). Conclusion   In the treatment of large olfactory groove meningiomas, microsurgery via extra lateral approach can significantly improve the effect of tumor resection, improve symptoms and reduce the occurrence of complications.

【Key words】 Bilateral subfrontal approach; Extra lateral approach; Microsurgery; Large olfactory groove meningiomas

嗅溝脑膜瘤是常见的颅内肿瘤, 发病率较高, 约10%~20%, 男性发病率低于女性[1]。因早期缺乏典型症状, 当出现明显症状就诊时, 肿瘤常常较大、位置较深, 可双侧生长或偏侧生长, 与颅底重要神经、血管关系密切, 可同时侵犯颅底骨质结构, 增加治疗难度。伴随着显微外科技术的不断发展与成熟, 显微手术已经成为此病的首选方式, 但其疗效受到入路方式不同而效果不同[2, 3]。回顾性分析本院收治的嗅沟脑膜瘤患者, 旨在为临床大型嗅沟脑膜瘤提供更好的治疗手段。现报告如下。