听神经瘤术后面神经功能损伤危险因素分析

doi:10.3877/cma.j.issn.2095-9141.2020.06.002

目的

分析影响听神经瘤患者术后短期及长期面神经功能的危险因素。

方法

回顾性分析厦门大学附属第一医院神经外科自2015年1月至2018年6月收治的62例听神经瘤患者的临床资料。于术后7 d及术后6个月对所有患者的面神经功能进行评估。收集可能与患者术后早期及长期面神经功能障碍存在相关性的因素，采用Logistic单因素与多因素回归对相关因素与患者术后短期及长期面神经功能的关系进行分析。

结果

术后7 d，21例（33.9%）患者面神经功能正常，41例（66.1%）患者出现面神经功能损伤；术后6个月，49例（79.0%）患者面神经功能为正常，13例（21.0%）患者面神经功能损伤。Logistic单因素回归分析结果显示：肿瘤最大直径越大、肿瘤与面神经黏连越紧密，患者术后7 d发生面神经功能损伤的可能性越大（P=0.002、0.002）；术前临床症状持续时间为患者术后6个月面神经功能障碍的危险因素（P=0.035）。Logistic多因素回归分析结果显示：肿瘤与面神经的黏连程度、肿瘤最大直径为患者术后7 d面神经功能障碍的独立危险因素（P=0.003、0.014）；术前临床症状持续时间、肿瘤最大直径为患者术后6个月面神经功能障碍的独立危险因素（P=0.010、0.030）。

结论

肿瘤与面神经的黏连越紧密、肿瘤最大直径越大，患者术后7 d发生面神经功能损伤的可能性越大。患者术前临床症状持续时间越长、肿瘤最大直径越大，术后6个月发生面神经功能损伤的可能性越大。

关键词: 听神经瘤, 面神经功能损伤, 肿瘤黏连

Objective

To analyze risk factors for short-term and long-term facial nerve function after acoustic neuroma surgery.

Methods

Sixty-two patients with acoustic neuroma admitted to Neurosurgery Department of the First Affiliated Hospital of Xiamen University from January 2015 to June 2018 were retrospectively analyzed. The facial nerve function of all patients was evaluated at 7 d and 6 months after surgery. The risk factors that may be related to the short-term and long-term facial nerve dysfunction were collected. The relationship between the related factors and the short-term and long-term facial nerve function was analyzed by Logistic regression.

Results

Seven days after surgery, 21 patients (33.9%) had normal facial nerve function, 41 patients (66.1%) had facial nerve function impairment; 6 months after surgery, 49 patients (79.0%) had normal facial nerve function, and 13 patients (21.0%) had facial nerve function impairment. Logistic univariate regression analysis showed that the larger the maximum diameter of the tumor and the tighter adhesion between tumor and facial nerve, the greater the possibility of facial nerve function nerve injury occurred 7 d after surgery (P=0.002, 0.002); the duration of clinical symptoms before surgery was the risk factor of facial nerve dysfunction 6 months after surgery (P=0.035). Logistic multivariate regression analysis showed that the degree of adhesion between the tumor and the facial nerve and the maximum tumor diameter were the independent risk factors for facial nerve dysfunction 7 d after surgery (P=0.003, 0.014); the duration of clinical symptoms before surgery and the maximum diameter of tumor were the independent risk factors of facial nerve dysfunction 6 months after surgery (P=0.010, 0.030).

Conclusion

The tighter the adhesion between the tumor and the facial nerve and the larger the maximum diameter of the tumor, the greater the possibility of facial nerve function injury occurred 7 d after surgery. The longer the duration of clinical symptoms and the larger the maximum diameter of tumor, the greater the possibility of facial nerve injury 6 months after surgery.

Key words: Acoustic neuroma, Facial nerve function injury, Tumor adhesion

表1 患者术后7 d及6个月面神经功能情况[例（%）]

House-Backmann评级		术后7 d	术后6个月
面神经功能正常		21(33.9)	49(79.0)
	Ⅰ	14(22.6)	22(35.5)
	Ⅱ	7(11.3)	27(43.5)
面神经功能损伤		41(66.1)	13(21.0)
	Ⅲ	26(41.9)	9(14.5)
	Ⅳ	10(16.1)	2(3.2)
	Ⅴ	4(6.5)	1(1.6)
	Ⅵ	1(1.6)	1(1.6)

表1 患者术后7 d及6个月面神经功能情况[例（%）]

House-Backmann评级		术后7 d	术后6个月
面神经功能正常		21(33.9)	49(79.0)
	Ⅰ	14(22.6)	22(35.5)
	Ⅱ	7(11.3)	27(43.5)
面神经功能损伤		41(66.1)	13(21.0)
	Ⅲ	26(41.9)	9(14.5)
	Ⅳ	10(16.1)	2(3.2)
	Ⅴ	4(6.5)	1(1.6)
	Ⅵ	1(1.6)	1(1.6)

表2 术后7 d面神经功能危险因素Logistic单因素分析

项目		面神经功能正常(n=21)	面神经功能损伤(n=41)	OR(95%CI)	P值
年龄（岁，±s）		50.10±12.67	49.88±12.12	0.999(0.956~1.043)	0.947
性别[例(%)]				0.786(0.268~2.304)	0.661
	男	8(38.1)	18(43.9)
	女	13(61.9)	23(56.1)
侧别[例(%)]				0.853(0.293~2.483)	0.771
	左侧	12(57.1)	25(61.0)
	右侧	9(42.9)	16(39.0)
肿瘤最大直径（cm，±s）		2.69±0.57	3.48±0.88	3.999(1.663~9.613)	0.002
术前临床症状持续时间（年，±s）		3.25±3.20	2.56±2.45	0.912(0.754~1.104)	0.346
肿瘤性质[例(%)]				1.153(0.507~2.621)	0.734
	囊性	2(9.5)	3(7.3)
	实性	9(42.9)	17(41.5)
	囊实性	10(47.6)	21(51.2)
内听道是否扩大[例(%)]				1.325(0.442~3.979)	0.615
	否	8(38.1)	13(31.7)
	是	13(61.9)	28(68.3)
面神经黏连程度[例(%)]
	无黏连	7(33.3)	1(2.4)	1(Ref)
	轻度黏连	8(38.1)	9(22.0)	7.875(0.788~78.670)	0.079
	紧密黏连	6(28.6)	31(75.6)	36.170(3.735~350.190)	0.002
脑干黏连程度[例(%)]				1.497(0.678~3.309)	0.318
	无黏连	4(19.0)	2(4.9)
	轻度黏连	7(33.3)	18(43.9)
	紧密黏连	10(47.6)	21(51.2)
手术时长（h，±s）		5.48±2.32	5.22+2.58	0.957(0.775~1.183)	0.686
术中出血量（mL，±s）		402.86±501.74	553.66±283.59	1.002(1.000~1.004)	0.136
病理分型				0.756(0.376~1.522)	0.434
	Antoni-A	2(9.5)	11(26.8)
	Antoni-B	10(47.6)	12(29.3)
	Antoni-A+B	9(42.9)	18(43.9)
术前听力分级[例(%)]				0.888(0.414~1.904)	0.760
	A	1(4.8)	0(0)
	B	0(0)	5(12.2)
	C	5(23.8)	8(19.5)
	D	15(71.4)	28(68.3)
Koos分级[例(%)]				1.943(0.558~6.769)	0.297
	1级	0(0)	0(0)
	2级	0(0)	0(0)
	3级	6(28.6)	7(17.1)
	4级	15(71.4)	34(82.9)
面神经位置[例(%)]				0.614(0.113~3.344)	0.573
	腹侧	2(9.5)	6(14.6)
	背侧	19(90.5)	35(85.4)

表2 术后7 d面神经功能危险因素Logistic单因素分析

项目		面神经功能正常(n=21)	面神经功能损伤(n=41)	OR(95%CI)	P值
年龄（岁，±s）		50.10±12.67	49.88±12.12	0.999(0.956~1.043)	0.947
性别[例(%)]				0.786(0.268~2.304)	0.661
	男	8(38.1)	18(43.9)
	女	13(61.9)	23(56.1)
侧别[例(%)]				0.853(0.293~2.483)	0.771
	左侧	12(57.1)	25(61.0)
	右侧	9(42.9)	16(39.0)
肿瘤最大直径（cm，±s）		2.69±0.57	3.48±0.88	3.999(1.663~9.613)	0.002
术前临床症状持续时间（年，±s）		3.25±3.20	2.56±2.45	0.912(0.754~1.104)	0.346
肿瘤性质[例(%)]				1.153(0.507~2.621)	0.734
	囊性	2(9.5)	3(7.3)
	实性	9(42.9)	17(41.5)
	囊实性	10(47.6)	21(51.2)
内听道是否扩大[例(%)]				1.325(0.442~3.979)	0.615
	否	8(38.1)	13(31.7)
	是	13(61.9)	28(68.3)
面神经黏连程度[例(%)]
	无黏连	7(33.3)	1(2.4)	1(Ref)
	轻度黏连	8(38.1)	9(22.0)	7.875(0.788~78.670)	0.079
	紧密黏连	6(28.6)	31(75.6)	36.170(3.735~350.190)	0.002
脑干黏连程度[例(%)]				1.497(0.678~3.309)	0.318
	无黏连	4(19.0)	2(4.9)
	轻度黏连	7(33.3)	18(43.9)
	紧密黏连	10(47.6)	21(51.2)
手术时长（h，±s）		5.48±2.32	5.22+2.58	0.957(0.775~1.183)	0.686
术中出血量（mL，±s）		402.86±501.74	553.66±283.59	1.002(1.000~1.004)	0.136
病理分型				0.756(0.376~1.522)	0.434
	Antoni-A	2(9.5)	11(26.8)
	Antoni-B	10(47.6)	12(29.3)
	Antoni-A+B	9(42.9)	18(43.9)
术前听力分级[例(%)]				0.888(0.414~1.904)	0.760
	A	1(4.8)	0(0)
	B	0(0)	5(12.2)
	C	5(23.8)	8(19.5)
	D	15(71.4)	28(68.3)
Koos分级[例(%)]				1.943(0.558~6.769)	0.297
	1级	0(0)	0(0)
	2级	0(0)	0(0)
	3级	6(28.6)	7(17.1)
	4级	15(71.4)	34(82.9)
面神经位置[例(%)]				0.614(0.113~3.344)	0.573
	腹侧	2(9.5)	6(14.6)
	背侧	19(90.5)	35(85.4)

表3 术后7 d面神经功能危险因素Logistic多因素分析

变量	偏回归系数	标准误	Wald值	P值	OR值	95%CI
肿瘤与面神经紧密黏连	1.514	0.511	8.792	0.003	4.545	1.671~12.363
最大直径	1.257	0.510	6.075	0.014	3.513	1.293~9.543

表3 术后7 d面神经功能危险因素Logistic多因素分析

变量	偏回归系数	标准误	Wald值	P值	OR值	95%CI
肿瘤与面神经紧密黏连	1.514	0.511	8.792	0.003	4.545	1.671~12.363
最大直径	1.257	0.510	6.075	0.014	3.513	1.293~9.543

表4 术后6个月面神经功能危险因素Logistic单因素分析

项目		面神经功能正常(n=49)	面神经功能损伤(n=13)	OR(95%CI)	P值
年龄（岁，±s）		49.63±12.27	51.20±12.23	1.011(0.960~1.064)	0.687
性别[例(%)]				0.543(0.158~1.862)	0.331
	男	19(38.8)	7(53.8)
	女	30(61.2)	6(46.2)
侧别[例(%)]				1.353(0.359~4.642)	0.630
	左侧	30(61.2)	7(53.8)
	右侧	19(38.8)	6(46.2)
肿瘤最大直径[cm，例(%)]		3.12±0.80	3.55±1.08	1.750(0.862~3.552)	0.121
术前临床症状持续时间（年，±s）		2.40±2.50	4.28±3.12	1.257(1.016~1.555)	0.035
肿瘤性质[例(%)]				0.713(0.279~1.819)	0.479
	囊性	3(6.1)	2(15.4)
	实性	21(42.9)	5(38.5)
	囊实性	25(51.0)	6(46.2)
内听道是否扩大[例(%)]				1.935(0.470~7.967)	0.360
	未扩大	18(36.7)	3(23.1)
	扩大	31(63.3)	10(76.9)
面神经黏连程度[例(%)]				2.677(0.818~8.763)	0.104
	无黏连	8(16.3)	3(23.1)
	轻度黏连	14(28.6)	0(0)
	紧密黏连	27(55.1)	10(76.9)
脑干黏连程度[例(%)]				0.499(0.201~1.237)	0.133
	无黏连	4(8.2)	2(15.4)
	轻度黏连	18(36.7)	7(53.8)
	紧密黏连	27(55.1)	4(30.8)
手术时长（h，±s）		5.40±2.49	4.96±2.49	0.926(0.711~1.208)	0.572
术中出血量（mL，±s）		508.37±392.96	480.77±309.26	1.000(0.998~1.002)	0.812
病理分型[例(%)]				0.733(0.335~1.602)	0.436
	Antoni-A	9(18.4)	4(30.8)
	Antoni-B	18(36.7)	4(30.8)
	Antoni-A+B	22(44.9)	5(38.5)
术前听力分级[例(%)]				0.644(0.294~1.412)	0.272
	A	1(2.0)	0(0)
	B	2(4.1)	3(23.1)
	C	11(22.4)	2(15.4)
	D	35(71.4)	8(61.5)
Koos分级[例(%)]				0.855(0.197~3.701)	0.834
	1级	0(0)	0(0)
	2级	0(0)	0(0)
	3级	10(20.4)	3(23.1)
	4级	39(79.6)	10(76.9)
面神经位置[例(%)]				0.767(0.137~4.337)	0.765
	腹侧	6(12.2)	2(15.4)
	背侧	43(87.8)	11(84.6)

表4 术后6个月面神经功能危险因素Logistic单因素分析

项目		面神经功能正常(n=49)	面神经功能损伤(n=13)	OR(95%CI)	P值
年龄（岁，±s）		49.63±12.27	51.20±12.23	1.011(0.960~1.064)	0.687
性别[例(%)]				0.543(0.158~1.862)	0.331
	男	19(38.8)	7(53.8)
	女	30(61.2)	6(46.2)
侧别[例(%)]				1.353(0.359~4.642)	0.630
	左侧	30(61.2)	7(53.8)
	右侧	19(38.8)	6(46.2)
肿瘤最大直径[cm，例(%)]		3.12±0.80	3.55±1.08	1.750(0.862~3.552)	0.121
术前临床症状持续时间（年，±s）		2.40±2.50	4.28±3.12	1.257(1.016~1.555)	0.035
肿瘤性质[例(%)]				0.713(0.279~1.819)	0.479
	囊性	3(6.1)	2(15.4)
	实性	21(42.9)	5(38.5)
	囊实性	25(51.0)	6(46.2)
内听道是否扩大[例(%)]				1.935(0.470~7.967)	0.360
	未扩大	18(36.7)	3(23.1)
	扩大	31(63.3)	10(76.9)
面神经黏连程度[例(%)]				2.677(0.818~8.763)	0.104
	无黏连	8(16.3)	3(23.1)
	轻度黏连	14(28.6)	0(0)
	紧密黏连	27(55.1)	10(76.9)
脑干黏连程度[例(%)]				0.499(0.201~1.237)	0.133
	无黏连	4(8.2)	2(15.4)
	轻度黏连	18(36.7)	7(53.8)
	紧密黏连	27(55.1)	4(30.8)
手术时长（h，±s）		5.40±2.49	4.96±2.49	0.926(0.711~1.208)	0.572
术中出血量（mL，±s）		508.37±392.96	480.77±309.26	1.000(0.998~1.002)	0.812
病理分型[例(%)]				0.733(0.335~1.602)	0.436
	Antoni-A	9(18.4)	4(30.8)
	Antoni-B	18(36.7)	4(30.8)
	Antoni-A+B	22(44.9)	5(38.5)
术前听力分级[例(%)]				0.644(0.294~1.412)	0.272
	A	1(2.0)	0(0)
	B	2(4.1)	3(23.1)
	C	11(22.4)	2(15.4)
	D	35(71.4)	8(61.5)
Koos分级[例(%)]				0.855(0.197~3.701)	0.834
	1级	0(0)	0(0)
	2级	0(0)	0(0)
	3级	10(20.4)	3(23.1)
	4级	39(79.6)	10(76.9)
面神经位置[例(%)]				0.767(0.137~4.337)	0.765
	腹侧	6(12.2)	2(15.4)
	背侧	43(87.8)	11(84.6)

表5 术后6个月面神经功能危险因素Logistic多因素分析

变量	偏回归系数	标准误	Wald值	P值	OR值	95%CI
肿瘤最大直径	0.975	0.449	4.703	0.030	2.650	1.098~6.396
症状持续时间	0.351	0.136	6.599	0.010	1.420	1.087~1.855

表5 术后6个月面神经功能危险因素Logistic多因素分析

变量	偏回归系数	标准误	Wald值	P值	OR值	95%CI
肿瘤最大直径	0.975	0.449	4.703	0.030	2.650	1.098~6.396
症状持续时间	0.351	0.136	6.599	0.010	1.420	1.087~1.855

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Analysis of risk factors of nerve function injury after acoustic neuroma surgery

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Analysis of risk factors of nerve function injury after acoustic neuroma surgery