脑膜瘤%外科手术,微创性%经眶上裂沟通颅眶入路
腦膜瘤%外科手術,微創性%經眶上裂溝通顱眶入路
뇌막류%외과수술,미창성%경광상렬구통로광입로
Meningioma%Surgical procedures,mimimally invasive%Communicate through the superior orbital fissure cranio-orbital approach
目的 探讨经眶上裂沟通颅眶入路的显微手术治疗颅底脑膜瘤的临床疗效.方法 将80例颅底脑膜瘤患者按照抽签方法随机均分为对照组与观察组,各为40例;对照组采用接触式显微手术,观察组采用经眶上裂沟通颅眶入路的显微手术,对两组手术效果、临床症状改善情况及术后并发症发生情况进行对比分析.结果 对照组手术时间、失血量、输血量、Simpson级别(Ⅰ、Ⅱ、Ⅲ级)、DKPS、术后住院天数及病死率分别为(9.28 ±0.97)h、(1 222.38±89.07) mL、(1 099.35±56.72) mL、14/17/9、3.21(0,6.44)、(29.78±3.29)d及7.50％(3/40),观察组分别为(7.02±0.65)h、(877.34±44.50) mL、(677.10 ±32.28)mL、29/9/2、3.26(-3.33,10)、(20.00±2.75)d及5.00％(2/40),两组在手术时间、失血量、输血量、Simpson级别、术后住院天数方面的差异均有统计学意义(t=4.209、4.997、5.823,x2=4.011,t=5.711,P=0.033、0.027、0.018、0.022、0.013),但两组DKPS与病死率差异均无统计学意义(x2 =0.433,t =0.096,P=0.089、0.317).对照组单眼突出、眼球活动障碍及视力改善率分别为66.67％、72.22％及75.68％,均显著高于观察组(分别为92.31％、94.12％及97.14％)(x2=5.932,4.381,6.793,P=0.027、0.033、0.020);对照组术后眼球活动障碍、上睑下垂、眼球外展受限、皮下积液及颅内感染率分别为10.00％、15.00％、30.00％、12.50％及7.50％,观察组分别为7.50％、5.00％、10.00％、10.00％及7.50％,两组术后眼球活动障碍、皮下积液及颅内感染发生率差异均无统计学意义(x2=0.923,1.033,0.785,P=0.387、0.595、0.233),两组术后上睑下垂、眼球外展受限发生率差异均有统计学意义(x2 =6.299,7.889,P=0.018、0.009).结论 颅底脑膜瘤经眶上裂沟通颅眶入路的显微手术效果显著,优于传统接触式显微手术,值得在临床上加以推广并应用.
目的 探討經眶上裂溝通顱眶入路的顯微手術治療顱底腦膜瘤的臨床療效.方法 將80例顱底腦膜瘤患者按照抽籤方法隨機均分為對照組與觀察組,各為40例;對照組採用接觸式顯微手術,觀察組採用經眶上裂溝通顱眶入路的顯微手術,對兩組手術效果、臨床癥狀改善情況及術後併髮癥髮生情況進行對比分析.結果 對照組手術時間、失血量、輸血量、Simpson級彆(Ⅰ、Ⅱ、Ⅲ級)、DKPS、術後住院天數及病死率分彆為(9.28 ±0.97)h、(1 222.38±89.07) mL、(1 099.35±56.72) mL、14/17/9、3.21(0,6.44)、(29.78±3.29)d及7.50％(3/40),觀察組分彆為(7.02±0.65)h、(877.34±44.50) mL、(677.10 ±32.28)mL、29/9/2、3.26(-3.33,10)、(20.00±2.75)d及5.00％(2/40),兩組在手術時間、失血量、輸血量、Simpson級彆、術後住院天數方麵的差異均有統計學意義(t=4.209、4.997、5.823,x2=4.011,t=5.711,P=0.033、0.027、0.018、0.022、0.013),但兩組DKPS與病死率差異均無統計學意義(x2 =0.433,t =0.096,P=0.089、0.317).對照組單眼突齣、眼毬活動障礙及視力改善率分彆為66.67％、72.22％及75.68％,均顯著高于觀察組(分彆為92.31％、94.12％及97.14％)(x2=5.932,4.381,6.793,P=0.027、0.033、0.020);對照組術後眼毬活動障礙、上瞼下垂、眼毬外展受限、皮下積液及顱內感染率分彆為10.00％、15.00％、30.00％、12.50％及7.50％,觀察組分彆為7.50％、5.00％、10.00％、10.00％及7.50％,兩組術後眼毬活動障礙、皮下積液及顱內感染髮生率差異均無統計學意義(x2=0.923,1.033,0.785,P=0.387、0.595、0.233),兩組術後上瞼下垂、眼毬外展受限髮生率差異均有統計學意義(x2 =6.299,7.889,P=0.018、0.009).結論 顱底腦膜瘤經眶上裂溝通顱眶入路的顯微手術效果顯著,優于傳統接觸式顯微手術,值得在臨床上加以推廣併應用.
목적 탐토경광상렬구통로광입로적현미수술치료로저뇌막류적림상료효.방법 장80례로저뇌막류환자안조추첨방법수궤균분위대조조여관찰조,각위40례;대조조채용접촉식현미수술,관찰조채용경광상렬구통로광입로적현미수술,대량조수술효과、림상증상개선정황급술후병발증발생정황진행대비분석.결과 대조조수술시간、실혈량、수혈량、Simpson급별(Ⅰ、Ⅱ、Ⅲ급)、DKPS、술후주원천수급병사솔분별위(9.28 ±0.97)h、(1 222.38±89.07) mL、(1 099.35±56.72) mL、14/17/9、3.21(0,6.44)、(29.78±3.29)d급7.50％(3/40),관찰조분별위(7.02±0.65)h、(877.34±44.50) mL、(677.10 ±32.28)mL、29/9/2、3.26(-3.33,10)、(20.00±2.75)d급5.00％(2/40),량조재수술시간、실혈량、수혈량、Simpson급별、술후주원천수방면적차이균유통계학의의(t=4.209、4.997、5.823,x2=4.011,t=5.711,P=0.033、0.027、0.018、0.022、0.013),단량조DKPS여병사솔차이균무통계학의의(x2 =0.433,t =0.096,P=0.089、0.317).대조조단안돌출、안구활동장애급시력개선솔분별위66.67％、72.22％급75.68％,균현저고우관찰조(분별위92.31％、94.12％급97.14％)(x2=5.932,4.381,6.793,P=0.027、0.033、0.020);대조조술후안구활동장애、상검하수、안구외전수한、피하적액급로내감염솔분별위10.00％、15.00％、30.00％、12.50％급7.50％,관찰조분별위7.50％、5.00％、10.00％、10.00％급7.50％,량조술후안구활동장애、피하적액급로내감염발생솔차이균무통계학의의(x2=0.923,1.033,0.785,P=0.387、0.595、0.233),량조술후상검하수、안구외전수한발생솔차이균유통계학의의(x2 =6.299,7.889,P=0.018、0.009).결론 로저뇌막류경광상렬구통로광입로적현미수술효과현저,우우전통접촉식현미수술,치득재림상상가이추엄병응용.
Objective To investigate the skull base meningiomas communicate through the superior orbital fissure cranio-orbital approach of microsurgical Methods and the efficacy.Methods 80 cases with skull base meningiomas were randomly divided into the control group and observation group,40 cases in each group.The control group was given contact microsurgery,and the observation group received communication through the superior orbital fissure cranio-orbital approach of micro-surgery.The improvement of symptoms and postoperative complications were compared and analyzed.Results (1)The operative time,blood loss,blood transfusion,Simpson grade (Ⅰ,Ⅱ,Ⅲgrade),DKPS,postoperative hospital stay and mortality rate in the control group were (9.28 ± 0.97)h,(1 222.38 ± 89.07) mL,(1 099.35 ±56.72) mL,14/17/9,3.21 (0,6.44),(29.78 ±3.29)d and 7.50％ (3/40),which in the observation group were (7.02 ± 0.65) h,(877.34 ± 44.50) mL,(677.10 ± 32.28) mL,29/9/2,3.26 (-3.33,10),(20.00 ± 2.75) d and 5.00％ (2/40).The differences of operative time,blood loss,blood transfusion,Simpson level,postoperative hospital stay between the two groups were statistically significant(t =4.209,4.997,5.823,x2 =4.011,t =5.711,P =0.033,0.027,0.018,0.022,0.013),but the D KPS and mortality between the two groups had no significant differences (t =0.433,0.096,P =0.089,0.317).The monocular prominent,eye movement disorder and vision improvement rates in the control group were 66.67％,72.22％ and 75.68％,which were significantly lower than 92.31％,94.12％ and 97.14％ in the observation group (x2 =5.932,4.381,6.793,P =0.027,0.033,0.020).The postoperative eye movement disorder,on ptosis,eye abduction,subcutaneous fluid and intracranial infection rates in the control group were 10.00％,15.00％,30.00％,12.50％ and 7.50％,those in the observation group were 7.50％,5.00％,10.00％,10.00％ and 7.50％.The postoperative eye movement disorder,subcutaneous fluid and intracranial infection rates had no significant differences between the two groups(x2 =0.923,1.033,0.785,P =0.387,0.595,0.233).The incidence rates of postoperative ptosis,abduction eyeball had statistically significant differences between the two groups (x2 =6.299,7.889,P =0.018,0.009).Conclusion The skull base meningiomas communicate through the superior orbital fissure cranio-orbital approach of microsurgery has significant effect than the conventional contact microsurgery,which deserves to be promoted in clinical.
