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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2021, Vol. 07 ›› Issue (05) : 271 -276. doi: 10.3877/cma.j.issn.2095-9141.2021.05.004

临床研究

改良直切口幕上下联合入路切除镰幕型小脑幕脑膜瘤的疗效分析
吴昊1, 沈宇晟1, 李云雷1, 吕明月1, 麦麦提力·米吉提1, 巴特·龚高昂1, 朱国华1,†()   
  1. 1. 830054　乌鲁木齐，新疆医科大学第一附属医院神经外科
  • 收稿日期:2020-12-17 出版日期:2021-10-15
  • 通信作者: 朱国华
  • 基金资助:
    新疆维吾尔自治区自然科学基金(2021D01C341)

Efficacy analysis of modified vertical incision combined with supratentorial approach for resection of falcate tentorial meningioma

Hao Wu1, Yusheng Shen1, Yunlei Li1, Mingyue Lyu1, Mijiti Maimaitili1, Gonggaoang Bate1, Guohua Zhu1,†()   

  1. 1. Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
  • Received:2020-12-17 Published:2021-10-15
  • Corresponding author: Guohua Zhu
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吴昊, 沈宇晟, 李云雷, 吕明月, 麦麦提力·米吉提, 巴特·龚高昂, 朱国华. 改良直切口幕上下联合入路切除镰幕型小脑幕脑膜瘤的疗效分析[J]. 中华神经创伤外科电子杂志, 2021, 07(05): 271-276.

Hao Wu, Yusheng Shen, Yunlei Li, Mingyue Lyu, Mijiti Maimaitili, Gonggaoang Bate, Guohua Zhu. Efficacy analysis of modified vertical incision combined with supratentorial approach for resection of falcate tentorial meningioma[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(05): 271-276.

目的

分析改良直切口幕上下联合入路并动态牵拉显微切除镰幕型小脑幕脑膜瘤的治疗效果。

方法

回顾性分析新疆医科大学第一附属医院神经外科自2013年1月至2020年1月收治的70例在接受初次手术的镰幕脑膜瘤患者的临床资料，其中35例患者采用改良直切口联合入路，35例患者采用单一入路。收集2组患者的一般资料（性别、年龄、肿瘤大小、肿瘤位置），分析2组患者手术相关因素（出血量、手术时间、深静脉损伤、肿瘤切除程度）、住院天数及术后并发症差异。

结果

2组患者术前一般资料比较差异无统计学意义（P>0.05），具有可比性。术后随访6个月，2组患者的出血量、手术时间、术后并发症发生率、住院天数比较，差异均无统计学意义（P>0.05）。改良直切口联合入路组术后1周、6个月的KPS评分大于单一入路组，差异有统计学意义（P<0.05）。改良直切口联合入路组与单一入路组的深静脉损伤、肿瘤切除率、皮质盲比较，差异均有统计学意义（P<0.05）。

结论

针对镰幕型小脑幕脑膜瘤，采用改良直切口联合入路手术打开幕上下硬膜后结合显微镜"锥形视野"和"动态牵拉"技术，可有效减少医源性脑损伤，能获得多角度广泛的深部术野，患者术后并发症发生率低，住院时间短，术后康复效果良好。

关键词: 小脑幕脑膜瘤, Poppen入路, Krause入路, 联合入路, 动态牵拉
Objective

To analysis the therapeutic effect of modified vertical incision combined with supratentorial approach and dynamic traction for microresection of falcate tentorial meningioma.

Methods

The clinical data of 70 patients with falcate tentorial meningioma who underwent primary operation in the Neurosurgery Department of the First Affiliated Hospital of Xinjiang Medical University from January 2013 to January 2020 were analyzed retrospectively. Among them, 35 patients adopted the modified straight incision combined approach and 35 patients adopted the single approach. The general data (gender, age, tumor size and tumor location) of the two groups were collected, and the differences of operation related factors (bleeding volume, operation time, deep vein injury, tumor resection degree), length of hospital stay and postoperative complications between the two groups were analyzed.

Results

There was no significant difference of general information between the two groups, and they were comparable. The patients were followed up for 6 months, there was no significant difference in the amount of bleeding, operation time, incidence of postoperative complications and length of hospital stay between the two groups (P>0.05). The KPS score of the modified straight incision combined approach group at 1 week and 6 months after operation was significantly higher than that of the single approach group (P<0.05). There were significant differences in deep vein injury, tumor resection rate and cortical blindness between the modified straight incision combined approach group and the single approach group (P<0.05).

Conclusion

For falcate tentorial meningioma, the improved straight incision combined with superior and inferior dural approach combined with microscope "conical field" and "dynamic traction" technique can effectively reduce iatrogenic brain injury, obtain a multi-angle and wide range of deep surgical fields. The incidence of postoperative complications is low, the hospital stay is short, and the postoperative rehabilitation effect is good.

Key words: Tentorial meningioma, Poppen approach, Krause approach, Combined approach, Dynamic traction
表1 2组患者术前一般资料比较
组别 例数 性别 年龄（岁，±s） 肿瘤大小[cm3，M（P25，P75）] 肿瘤位置
男 女 幕上下偏左 幕上下双侧 幕上下偏右
改良直切口联合入路组 35 11 24 53.21±10.63 76.62（39.63，120.21） 6 13 16
单一入路组 35 12 23 52.91±10.32 57.82（37.21，88.14） 5 19 11
t/χ2/Z值   0.065 0.126 -1.145 2.142
P值   0.799 0.900 0.252 0.343
图1 镰幕脑膜瘤患者术前术后MRI增强图片
图2 镰幕脑膜瘤患者术中图片
表2 2组患者的手术相关因素和术后并发症比较
项目 改良直切口联合入路组（n=35） 单一入路组（n=35） t/χ2/Z值 P值
术中指标        
  出血量（mL，±s） 547.41±82.23 565.73±102.71 -0.822 0.414
  手术时间（h，±s） 5.69±0.77 5.87±1.06 -0.840 0.404
  深静脉损伤率[例（%）] 1（2.86） 7（20.00） - 0.028
KPS评分[M（P25，P75）]        
  术后1周 80（80，90） 80（70，80） -2.314 0.021
  术后6个月 90（90，90） 90（80，90） -3.273 0.001
肿瘤切除程度[例（%）]     8.742 0.003
  全切 34（97.14） 25（71.43）    
  大部分切除 1（2.86） 10（28.57）    
术后并发症[例（%）]        
  静脉窦损伤 2（5.71） 0 - 0.493
  术后复视 2（5.71） 5（14.29） - 0.428
  感染 5（14.29） 7（20.00） -0.634 0.529
  术后偏瘫 1（2.86） 2（5.71） - 1
  深静脉血栓 5（14.29） 10（28.57） 2.121 0.145
  脑积水 1（2.86） 1（2.86） - 1
  皮质盲 0 6（20.69） - 0.026
住院天数[d，M（P25，P75）] 9（8，10） 9（8，14） -0.391 0.699
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