本文選題：孤立顳角綜合征 + 局限性腦積水　； 參考：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:孤立顳角綜合征屬于一種特殊類型的局限性腦積水,可發(fā)生在側(cè)腦室三角區(qū)腦膜瘤切除術(shù)后,屬于一種嚴(yán)重的并發(fā)癥,可危及患者生命。然而,導(dǎo)致這種并發(fā)癥形成和發(fā)生的危險因素在文獻(xiàn)中較少被提及。因此,探索并分析導(dǎo)致側(cè)腦室三角區(qū)腦膜瘤切除術(shù)后發(fā)生孤立顳角綜合征的危險因素,對于預(yù)防和減少這種嚴(yán)重的并發(fā)癥具有重要意義。方法:對北京天壇醫(yī)院從2011年11月到2015年3月收治的121例側(cè)腦室三角區(qū)腦膜瘤手術(shù)的病例進(jìn)行回顧性分析,將患者的一般情況、臨床表現(xiàn)、影像學(xué)資料、手術(shù)過程、術(shù)后并發(fā)癥及術(shù)后的隨訪情況進(jìn)行統(tǒng)計學(xué)分析。結(jié)果:該組病例的中位隨訪時間為24.1個月,總共有23例(19.8%)三角區(qū)腦膜瘤的患者術(shù)后出現(xiàn)孤立顳角綜合征。單因素分析顯示較年輕患者(40歲)、病史時間較長(3個月)、術(shù)后出現(xiàn)腦膜炎及術(shù)后腦室外引流時間較長者出現(xiàn)孤立顳角的風(fēng)險明顯增加。進(jìn)一步行多因素Logistics回歸分析發(fā)現(xiàn),術(shù)前臨床病史3個月(OR=4.8,P=0.008)、術(shù)后出現(xiàn)神經(jīng)功能缺失(OR=4.2,P=0.014)、術(shù)后腦室外引流管留置時間3天(OR=4.8,P=0.012)及術(shù)后出現(xiàn)腦膜炎(OR=9.9,P=0.001)是導(dǎo)致術(shù)后發(fā)生孤立顳角綜合征的獨立的危險因素。結(jié)論:三角區(qū)腦膜瘤術(shù)后孤立顳角綜合征的發(fā)生率較高,術(shù)區(qū)周圍腦室壁的完整性遭到破壞、損傷可導(dǎo)致孤立顳角綜合征的發(fā)生。此外,術(shù)后對腦室外引流管和腦膜炎的管理非常重要。術(shù)后是否留置腦室外引流管應(yīng)根據(jù)每個患者的具體情況進(jìn)行個體化決定,患者術(shù)后若無特殊情況,應(yīng)盡早拔除腦室外引流管,防止腦脊液過度引流,從而防止腦室壁發(fā)生過度塌陷,引起互相粘連,導(dǎo)致孤立顳角綜合征的發(fā)生。
[Abstract]:Objective: isolated temporal horn syndrome belongs to a special type of localized hydrocephalus. It can occur after the resection of meningioma in the lateral ventricle trigonometry. It is a serious complication and can endanger the life of the patients. However, the risk factors leading to the formation and occurrence of such complications are less mentioned in the literature. Therefore, it is of great significance to explore and analyze the risk factors leading to the occurrence of isolated temporal horn syndrome after resection of meningiomas in the trigonometric region of the lateral ventricle, which is of great significance in preventing and reducing this serious complication. Methods: from November 2011 to March 2015, 121 cases of meningioma in the trigonometric region of lateral ventricle were treated in Temple of Heaven Hospital in Beijing. The general situation, clinical manifestation, imaging data and surgical procedure were analyzed retrospectively. Postoperative complications and postoperative follow-up were statistically analyzed. Results: the median follow-up time was 24.1 months. In total, 23 patients with trigonometric meningioma developed solitary temporal horn syndrome. Univariate analysis showed that the younger patients were 40 years old and had a longer history (3 months). The risk of postoperative meningitis and postoperative ventricular drainage was significantly higher than that of elderly patients with isolated temporal horn. Further multivariate Logistics regression analysis showed that, The clinical history of preoperation was 4. 8% P0. 008, the nerve function loss was 4. 2% P0. 014, the 3 days after operation, the indwelling time of ventricular drainage tube was 4. 8% P0. 012) and the occurrence of meningitis was 9. 9% P0. 001) were the independent risk factors for the occurrence of isolated temporal horn syndrome after the operation. The clinical history was 4. 8% P0. 008, and the postoperative time of left ventricular drainage tube was 4. 8% P0. 012) and 9. 9% P0. 001 of meningitis. Conclusion: the incidence of isolated temporal horn syndrome after operation of trigonometric meningioma is high. The integrity of the ventricular wall around the operation area is damaged and the injury can lead to the occurrence of isolated temporal horn syndrome. In addition, postoperative management of ventricular drainage tube and meningitis is very important. The individual decision should be made according to the specific conditions of each patient. If there is no special situation, the patient should remove the ventricular drainage tube as soon as possible to prevent the excessive drainage of cerebrospinal fluid. Thus preventing excessive collapse of the ventricular wall, resulting in adhesion, leading to the occurrence of isolated temporal horn syndrome.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.45

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 李學(xué)真;趙繼宗;;側(cè)腦室三角區(qū)腦膜瘤的手術(shù)治療[J];中華醫(yī)學(xué)雜志;2006年33期

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