發(fā)布時間：2018-05-01 21:08

  本文選題：蝶骨嵴腦膜瘤 + 凋亡抑制蛋白Survivin��； 參考：《華中科技大學》2015年博士論文

【摘要】：目的：探討凋亡抑制蛋白Survivin (LAPS)在蝶骨嵴腦膜瘤(SWMs)中表達的意義并分析IAPS表達與SWMs臨床預后的關(guān)系,為評估SWMs的發(fā)展狀態(tài)和預測臨床預后提供新的參考依據(jù)。 方法：1.總結(jié)2000年1月至2014年10月期間華中科技大學附屬同濟醫(yī)院神經(jīng)外科收治的84例SWMs患者的臨床資料及術(shù)后隨訪資料,按照腫瘤不同的特征對樣本進行分層,并對隨訪期間復發(fā)及死亡的相關(guān)資料進行匯總分析。2.采用SP免疫組織化學方法,檢測不同特征SWMs病理標本組織切片中IAPS的表達情況,統(tǒng)計IAPS陽性表達率及表達強度的差異,分析IAPS表達與SWMs臨床預后的關(guān)系。 結(jié)果：1.本組84例樣本中IAPS的陽性表達率為53.6%,其陽性表達率及表達強度在不同病理級別、侵犯顱骨骨質(zhì)與否、死亡與否、原發(fā)首次手術(shù)與復發(fā)再次手術(shù)、復發(fā)與未復發(fā)樣本之間存在明顯差異。2.高IAPS表達強度(Intensity Distribution Score,IDS6-12)患者死亡和復發(fā)風險明顯高于低IAPS表達強度(IDS0-4)患者。 結(jié)論：1.IAPS在SWMs中存在高表達,并和腦膜瘤的病理組織學分級密切相關(guān),其陽性表達率及表達強度隨腫瘤的病理級別增高而增高。2.伴顱骨骨質(zhì)侵襲、復發(fā)及死亡樣本的IAPS陽性表達率及表達強度均高于不伴顱骨骨質(zhì)侵襲、未復發(fā)及存活的樣本。3.IAPS在SWMs的發(fā)生、發(fā)展及演變中扮演了重要的角色,其高表達狀態(tài)可做為評估患者術(shù)后復發(fā)或死亡風險性的參考指標。 目的：探討蝶骨嵴腦膜瘤(SWMs)的顯微外科手術(shù)策略并分析影響其術(shù)后復發(fā)的相關(guān)因素,為提高SWMs的手術(shù)全切除率及降低術(shù)后復發(fā)率提供新的思路和方法。 方法：回顧性分析2004年1月至2014年10月期間,華中科技大學附屬同濟醫(yī)院神經(jīng)外科顯微外科手術(shù)切除的121例SWMs患者的臨床資料和術(shù)后隨訪資料。對不同臨床特征SWMs的手術(shù)策略進行分類總結(jié),并將可能影響其術(shù)后復發(fā)的因素如：性別、年齡、腫瘤的形態(tài)、生物學行為特征、手術(shù)切除程度和病理級別等資料進行分類統(tǒng)計學分析。應用Kaplan-Meier法、log-rank檢驗及Cox比例風險回歸模型分析影響SWMs術(shù)后復發(fā)的相關(guān)危險因素。 結(jié)果：1.本組121例病例總體全切除率(Simpson Ⅰ級和Ⅱ級)為61.2%。術(shù)后死亡2例,109例患者獲嚴密隨訪,腫瘤復發(fā)28例,復發(fā)率25.7%,‘復發(fā)時間為8月-74月不等,平均39.1個月。2.統(tǒng)計分析顯示：性別、年齡、腫瘤大小及位置與SWMs術(shù)后復發(fā)無明顯相關(guān)性；腫瘤的不同生物學行為特征、手術(shù)切除程度和病理分型與SWMs術(shù)后復發(fā)存在一定的相關(guān)性。 結(jié)論：1.術(shù)中遵循嚴格蛛網(wǎng)膜層面操作、對腫瘤實施去血管化、盡可能施行原位切除等顯微手術(shù)策略,可以大大提高手術(shù)的安全性并獲得滿意的手術(shù)效果。2.針對不同生物學行為特征的SWMs,采用不同的顯微手術(shù)技巧,可以在最大程度減少周圍腦組織損傷的基礎(chǔ)上,實現(xiàn)最大范圍的腫瘤切除,提高腫瘤的全切除率是降低術(shù)后復發(fā)率的重要手段。3.腫瘤侵犯海綿竇或顱骨骨質(zhì)、包繞頸內(nèi)動脈及其分支、惡性病理學特征及未能實現(xiàn)全切除是影響SWMs術(shù)后復發(fā)的獨立危險因素,可做為預測SWMs術(shù)后復發(fā)危險性的參考因素。
[Abstract]:Objective: To investigate the significance of the expression of apoptosis inhibitory protein Survivin (LAPS) in sphenoid ridge meningioma (SWMs) and to analyze the relationship between IAPS expression and the clinical prognosis of SWMs, so as to provide a new reference for evaluating the development of SWMs and predicting the prognosis of the clinical prognosis.
Methods: 1. to sum up the clinical data and follow-up data of 84 SWMs patients admitted to Department of Neurosurgery of Tongji Hospital Affiliated to Huazhong University of Science and Technology from January 2000 to October 2014. According to the different characteristics of the tumor, the samples were stratified, and the related data of recurrence and death during the follow-up period were summarized and analyzed by.2. immunohistochemistry. To study the expression of IAPS in the tissue sections of SWMs pathological specimens of different characteristics, the difference of IAPS positive expression rate and expression intensity were statistically analyzed, and the relationship between the expression of IAPS and the clinical prognosis of SWMs was analyzed.
Results: 1. the positive expression rate of IAPS in 84 samples of the group was 53.6%, the positive expression rate and expression intensity were at different pathological grades, the invasion of skull bone or not, the death or not, the original first operation and recurrence, and the significant difference of.2. high IAPS expression between the relapse and the non recurrent samples (Intensity Distribution Score, IDS6 -12) the risk of death and recurrence was significantly higher than that of patients with low IAPS expression (IDS0-4).
Conclusion: 1.IAPS is highly expressed in SWMs and is closely related to the histopathological classification of meningiomas. The positive expression rate and expression intensity of the tumor increase with the histopathological grade of the tumor, which increases.2. with the invasion of the skull bone. The positive expression rate and expression intensity of the IAPS in the recurrent and dead samples are higher than that without the invasion of the skull bone, no recurrence and survival. The living sample.3.IAPS plays an important role in the occurrence, development and evolution of SWMs, and its high expression can be used as a reference for assessing the risk of postoperative recurrence or death of patients.
Objective: To explore the microsurgical strategy of sphenoid ridge meningioma (SWMs) and to analyze the related factors that affect the recurrence of the postoperatively, so as to provide new ideas and methods for improving the total resection rate of SWMs and reducing the recurrence rate after operation.
Methods: the clinical data and follow-up data of 121 SWMs patients who were removed from the Department of Neurosurgery of Tongji Hospital, Huazhong University of Science and Technology from January 2004 to October 2014 were analyzed retrospectively. The surgical strategies of different clinical features of SWMs were classified and the factors that might affect the recurrence of the patients, such as sex, were analyzed. Age, tumor morphology, biological behavior characteristics, surgical excision degree and pathological grade were classified and analyzed. Kaplan-Meier, log-rank test and Cox proportional risk regression model were used to analyze the related risk factors of recurrence after SWMs.
Results: 1. the total total resection rate of 121 cases (grade Simpson I and II) was 2 cases of death after 61.2%. and 109 patients were followed up closely. The recurrence rate was 25.7%. The recurrence time was -74 months in August. The average.2. statistical analysis of 39.1 months showed that sex, age, tumor size and location were not obvious after SWMs. Correlation, the different biological behavior characteristics of tumor, surgical resection degree and pathological type were correlated with recurrence after SWMs.
Conclusion: in the 1. operation, the operation of the arachnoid layer is strictly followed, the tumor is removed from the tumor, and the microsurgical strategy can be performed as far as possible. It can greatly improve the safety of the operation and obtain the satisfactory results of the operation.2. for different biological behavior characteristics of SWMs. On the basis of the injury of the surrounding brain tissue, the maximum resection of the tumor and the improvement of total resection rate of the tumor are the important means to reduce the recurrence rate after the operation:.3. tumor invasion of the cavernous sinus or the skull bone, the internal carotid artery and its branches, the malignant pathological characteristics and the failure to realize total resection is an independent risk factor for the recurrence of SWMs after the operation. It can be used as a reference factor to predict the risk of recurrence after SWMs.

【學位授予單位】：華中科技大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R739.45

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