矢状窦中部窦镰旁脑膜瘤的显微外科手术疗效观察

目的观察显微外科手术治疗矢状窦中部窦镰旁脑膜瘤的临床效果。方法选择2004年1月～2012年1月采用显微外科手术治疗的矢状窦中部矢状窦大脑镰旁脑膜瘤患者21例为A组,选择1996年1月～2012年1月应用常规手术治疗的矢状窦中部矢状窦大脑镰旁脑膜瘤患者15例为B组,比较两组术中出血量、术区出血率、症状改善率、肿瘤切除情况、癫痫控制、并发症及复发情况。结果 B组术中出血量为（800±220）mL,肿瘤全切除率为66.7%,症状改善率为80.0%,术区再出血率为20.0%。A组术中出血量为（400±150）mL,肿瘤全切除率为88.0%,症状改善率为92.0%,术区出血率为8.0%。两组均无死亡病例,A组的术中出血量明显少于B组,A组术后术区再出血率明显低于B组,A组临床症状改善率明显高于B组,两组上述各临床观察指标比较,差异有高度统计学意义（P〈0.01）。A组的全切率达92.0%,明显高于B组,差异有高度统计学意义（P〈0.01）;A组术前有癫痫11例,7例患者癫痫消失,4例患者抗癫痫用药量减少,无术后新发生癫痫患者。B组术前有癫痫9例,3例患者癫痫消失,2例发作次数明显减少,其余4例需长期口服抗癫痫药物治疗。结论显微外科手术治疗矢状窦中部窦镰旁脑膜瘤疗效确切,安全性好,操作简单,其能明显减少术中出血,减少术后血肿形成,提高肿瘤全切除率,改善临床症状,其临床效果明显优于常规开颅手术,值得广泛推广和应用。

Observation of curative effect of mi crosurgery on parasagittal and falx meningioma in middle sagittal sinus

Objective To observe the curative effect of microsurgery on parasagittal and falx meningioma in middle sagittal sinus.Methods 21 patients with parasagittal and falx meningiomas in middle sagittal sinus from January 2004 to January 2012 were collected as group A,15 patients with parasagittal and falx meningiomas in middle sagittal sinus from January 1996 to January 2012 were collected as the group B.Bleeding rates of blood loss,surgery area,the rate of improvement of symptoms,tumor resection,seizure control,complications and recurrence were compared between two groups.Results Intraoperative blood loss in group B were（800 ±220） mL,total tumor resection rate was 66.7%,improvement rate of 80.0%,postoperative rebleeding rate was 20.0%;intraoperative blood loss in group A were（400 ± 150） mL,tumor resection rate was 88.0%,the rate of symptom improvement rate was 92.0%,improvement rate was 8.0%.There was no mortality in two groups,the volume of bleeding in group A was obviously less than those in group B,operation zone rebleeding rate in group A was significantly lower than that in B group,the clinical symptoms of group A improved rate was significantly higher than that of group B,the differences were statistically significant（P〈0.01）.In group A,the rate of total resection was 92.0%,it was higher than that in group B,the difference was statistically significant（P〈0.01）;11 cases of epilepsy were found in group A,epilepsy symptom was found disappeared in 7 patients,the dosage of anti-epileptic drags were found reduced in 4 patients,no postoperative new epilepsy patient was found.9 cases of epilepsy were found in group B,epilepsy symptom was found disappeared in 3 patients,seizure frequency were found reduced obviously in 2 cases,long-term oral treatment with anti-epileptic drugs were found in 4 patients.Conclusion Microsurgery enhances the completeness of meningioma resection,reduces the intraoperative bleeding and postoperative rebleeding,improves patients′s ymptoms.Its effect is much better than the routine surgical operations＇,and is worthy of application and spread.