岩斜区良性肿瘤手术治疗策略分析

目的 探讨岩斜区良性肿瘤的手术策略.方法 对2002年1月至2009年2月的55例岩斜区良性肿瘤(脑膜瘤和三叉神经鞘瘤)患者的手术资料进行回顾性分析.依据不同手术策略将患者分为3组:全切除组、次全切除组及部分切除组,后两组患者又统一为非全切除组,术后行放疗控制复发或进展.对3组患者术后神经障碍发生率和生存质量状况进行统计分析.结果 55例患者中全切除21例,次全切除22例,部分切除12例.术后两周内全切除组有12例出现神经功能恶化,非全切除组有10例,其余患者稳定或好转.全切除组和非全切除组比较差异有统计学意义(x2=4.16,P＜0.05).术后1年内全切除组KPS≥80分12例,非全切除组为29例.全切除组和非全切除组比较差异有统计学意义(x2=5.42,P＜0.05).术后平均随访3年,全切除组无复发,非全切除组放疗后共计5例复发或进展.结论 岩斜区肿瘤追求全切除存在术后神经功能恶化和生存质量下降的风险,不追求全切除结合术后放疗可以达到较好的治疗效果.

Analysis of surgical treatment strategies of petroclival region tumors

Objective To explore the surgical strategy of the tumors of petroclival region. Methods The surgical data of 55 cases presented with meningioma and trigeminal nerve sheath tumors from January 2002 to February 2009 was retrospectively analyzed. All the cases were divided into full-cut group, sub-total resection group, part of resection group or divided into full-cut group and no-total resection group,in terms of various surgical strategy. The incidence of postoperative neurological disorder and quality of life status were focused and statistical analysis was carried out. Results There were 21 patients with complete cut,22patients with sub-total resection and 12 patients with part of resection. There were 12 patients with neurological deterioration in full-cut group and 10 patients in no-total resection group. There was significant difference between total resection group and no-total resection group(X2 =4.16 ,P＜0.05). All the patients were assessed based on the criterion of KPS, 12 patients of full-cut whose KPS≥80,29 patients were the same in no-total resection group. There was significant difference between the two groups (X2=5.42,P＜0.05). The mean follow-up time was 3 years. No recurrence was found in full-cut group and 5 recurrence of no-total resection group. Conclusions The pursuit of full-cut for the tumors of petroclival region may result in serious neurological dysfunction and poor life quality after the operation. Non-full-cut combination of postoperative radiotherapy may receive a relative better results.