颅内肿瘤手术中并发非手术区域血肿的危险因素分析

摘要

目的 分析颅内肿瘤手术中并发非手术区域血肿的机制及危险因素.方法 回顾性分析本院2009年3月-2016年12月行颅内肿瘤切除术的5 229例患者资料,将术中CT(intraoperative computed tomography,iCT)及术中MRI(intraoperativemagnetic resonance imaging,iMR)辅助手术并发非手术区域颅内出血的25例作为血肿组,按1∶2选择未发生远隔部位出血的肿瘤手术50例作为对照组.对两组病例肿瘤大小、脑积水、脑萎缩、糖尿病、高血压、病理类型、术中出血量、手术时间、肿瘤部位等资料进行单因素分析和多因素Logistic回归分析;术后3个月采用格拉斯哥预后评分(Glasgow outcomescale,GOS)分析两组预后差异.结果 本组患者颅脑肿瘤手术中并发非手术区域颅内血肿的发生率为0.47％.单因素分析显示两组脑积水、脑萎缩、肿瘤大小、术中出血量、手术时间差异有统计学意义(P＜0.05),Logistic回归分析显示肿瘤大小、合并脑积水和脑萎缩是脑肿瘤手术并发远隔部位颅内血肿的独立危险因素(P＜0.05).两组预后无统计学差异(P＞ 0.05).结论 颅脑肿瘤手术并发非手术区域血肿的危险因素有肿瘤大小、脑积水、脑萎缩等因素.术中CT及术中MRI检查可第一时间发现非手术区域颅内血肿,应及时清除血肿,从而极大改善预后.%Objective To analyze the mechanism and risk factors of hematoma in remote region following intracranial tumor resection.Methods Medical records of 5 229 patients underwent intracranial tumor resection in our hospital from March 2009 to December 2016 were retrospectively analyzed.Take 25 cases with remote intracranial hemorrhage as the hematoma group,whose surgeries were assited by intraoperative CT (intraoperative computed tomography,iCT) or intraoperative MRI (intraoperative magnetic resonance imaging,iMR),and 50 cases of intracranial tumor resection without ocurrence of hematoma were selected as the control group.Tumor size,hydrocephalus,cerebral atrophy,diabetes,hypertension,pathological type,intraoperative blood loss,operating time,tumor location and other information of the two groups were analyzed by univariate and multivariate logistic regression analysis.The differences of prognosis were evaluated by Glasgow outcome scale (GOS) 3 months after operation.Results The occurrence rate of remote intracranial hematoma was 0.47％ in the patients with craniocerebral operation.Univariate analysis showed that there were significant differences in hydrocephalus,brain atrophy,tumor size,intraoperative blood loss and operating time between groups (P ＜ 0.05,respectively).Multivariate logistic regression analysis showed that tumor size,hydrocephalus and brain atrophy were independent risk factors for remote intracranial hematoma in surgery for brain metastases (P ＜ 0.05,respectively).There was no significant difference of prognosis between hematoma group and control group (P ＞ 0.05).Conclusion Tumor size,cerebral hydrocephalus,cerebral atrophy were listed as the risk factors of remote intracranial hematoma following intracranial tumor resection,which can be found on time by intraoperative CT and MRI and can be removed to greatly improve the prognosis.