【作者】 蒋恒；

【导师】 黄海燕；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2023， 硕士

【摘要】 目的:探究鞍区脑膜瘤患者的临床特征及影响其术后生活质量的因素方法:本研究共纳入鞍区脑膜瘤患者100例并获取完整的临床及随访资料,入组病例均为2017年10月至2022年10月就诊于吉林大学第一医院并经术中确认肿瘤具体位置位于鞍区(鞍结节、鞍膈、前床突及鞍旁等),术后病理确诊为脑膜瘤的患者,所有患者术前均行影像学检查,包括计算机断层扫描(Computed Tomography,CT)和核磁共振影像(Magnetic Resonance Imaging,MRI)。所有患者均经术后随访,随访时间3个月-5年不等,随访方式包括网络通信随访、电话随访及门诊复查等。随访内容主要包含患者术后视力恢复变化情况,个人生活自理情况、工作能力等,并对所获随访资料进行详细且准确记录用于计算每位患者的国际标准KPS评分(Karnofsky performance scale,KPS)以进行生活质量评估。最后将所有患者的术前、术后及相关随访资料进行整理,采用SPSS25.0软件进行统计学分析,对可能对患者术后生活质量造成影响的相关因素进行非参数单因素秩和检验分析及多因素logistic回归分析,对不同时期患者生活质量KPS评分采用卡方检验进行比较。所有统计分析结果以P<0.05认为有统计学意义。结果:本次研究纳入的100例患者中,以视力减退为主要首发症状(占比53%),同时,头痛是另一常见首发症状(占比22%)。对100例患者术后生活质量可能有影响的相关因素进行非参数单因素秩和检验分析及多因素logistic回归分析,并对不同时期患者生活质量KPS评分采用卡方检验进行比较,分析发现影响患者术后生活质量的因素有:术前视力下降程度(P=0.008)、肿瘤与垂体柄的关系(P=0.006)、肿瘤与视神经的关系(P=0.001)、肿瘤与颈内分支及其关系(P<0.001)、入院时KPS评分(P<0.001)、手术后视力恢复情况(P<0.001)、病理分级(P=0.007)、手术肿瘤切除程度(P<0.001)。对相关因素进行多因素logistic回归分析后,发现肿瘤与垂体柄的关系、肿瘤与颈内分支及其关系、术前视力下降程度、手术肿瘤切除程度是影响患者术后生活质量的独立危险因素。结论:1、鞍区脑膜瘤的主要以视力减退为首发症状,头痛是本病的另一常见症状;2、积极的外科手术治疗可有效的改善患者视力下降视野损害的症状,有利于提高甚至恢复正常视力以大幅提高患者术后的生活质量;3、术前视力下降持续时间及程度、肿瘤与垂体柄、视神经及颈内分支的关系、入院KPS评分、术后视力恢复状况、肿瘤病理分级、肿瘤病灶清理程度是影响预后的相关因素;其中肿瘤与垂体柄和颈内分支的关系、术前视力下降程度、肿瘤病灶清理程度是影响患者术后生活质量的独立危险因素。更多还原

【Abstract】 Objective:To explore the clinical characteristics of patients with sellar region meningioma and the factors affecting their postoperative quality of life.Methods:This study was included in a total of 100 patients with meningoma in the saddle area and obtained complete clinical and follow-up materials.The cases of admission were visited from October 2017 to October 2022 at the First Hospital of Jilin University and confirmed that the specific position of the tumor was located in the surgery.The saddle area(saddle nodule,saddle diaphragm,front bed,beside the saddle,etc.),postoperative pathological diagnosis diagnosed as a meningoma,all patients performed imaging examination before surgery,including computer tomography(CT)Magnetic Resonance Image(MRI).All patients are followed up after surgery,and the follow-up time ranges from 3 months to 5years.The follow-up methods include online communication follow-up,telephone follow-up,and outpatient review.The contents of the follow-up mainly include the patient’s postoperative vision recovery and changes,the self-care of the personal life,and the ability to work,and the data obtained and accurately recorded the international standard KPS(Karnofsky Performance Scale)score for each for the quality of life.Finally,organize all patients’ pre-surgery,postoperative and related follow-up materials,and use SPSS25.0software for statistical analysis.Multi-factor Logistic regression analysis,compares the derived test of the KPS score of patients in different periods.All statistical analysis results are considered statistically significant in P <0.05Results:Among the 100 patients incorporated in this study,the main first symptoms(53%)were based on vision loss.At the same time,headache was another common first symptom(22%).A non-parameter single factors and test analysis of 100 patients’ after surgery may affect the relevant factors that have an impact on the quality of life,and the analysis of multi-factor logistic regression analysis.The factors of the quality of life after surgery are: the degree of vision decreased(P = 0.008),the relationship between tumor and pituitary handle(P =0.006),the relationship between tumor and optic nerve(P <0.001),the KPS score(P <0.001)at the admission,the recovery of vision after surgery(P <0.001),the pathological grading(P= 0.007),and the degree of surgical tumor resection(P <0.001).After multivariate logistic regression analysis of related factors,it was found that the relationship between the tumor and the pituitary stalk,the relationship between the tumor and the internal cervical branch,degree of preoperative vision loss,and the degree of surgical tumor resection were independent risk factors affecting the quality of life of patients after surgery.Conclusion:1.The main symptoms of vision loss in the saddling area are the first symptoms of vision loss.Headache is another common symptom of the disease;2.Active surgical treatment can effectively improve the symptoms of patient vision reduction in vision,which is conducive to improving or even restoring normal vision to greatly improve the quality of life after surgery;3.The duration and degree of preoperative vision loss,the relationship between tumor and pituitary stalk,optic nerve and internal cervical branch,admission KPS score,postoperative visual recovery status,tumor pathological grade,and degree of tumor lesion clearance are related factors affecting prognosis;The relationship between the pituitary stalk and the internal cervical branch,the degree of preoperative vision loss,and the degree of debridement of tumor lesions are independent risk factors affecting the quality of life of patients after surgery.更多还原