胶质瘤扩大切除术后神经状况和生命质量的评估

摘要

目的 探讨颅内胶质瘤扩大切除术所致患者神经系统功能和神经心理学状态的改变及其对生命质量的影响.方法 回顾性纳入2014年1月至2015年11月南京医科大学第一附属医院神经外科收治的行扩大切除术的58例胶质瘤患者.分别于手术前1d、出院时、术后3个月采用美国国立卫生院卒中量表(NIHSS)、Addenbrooke改良认知评估量表(ACE-R)、医院焦虑抑郁情绪测量表(HAD)以及韦氏成人智力测验与成套神经心理学测验来评估患者的神经系统功能和神经心理学状态,生命质量则使用欧洲癌症研究与治疗组织生命质量核心量表(EORTC QLQ-C30)进行评估.结果 患者的总体生命质量评分在术前1d(58例)、出院时(50例完成评估)以及术后3个月(获随访46例)分别为67.8(48.9,86.7)分、66.7(47.5,85.9)分以及64.8(41.4,88.5)分,且差异无统计学意义(P＞0.05).与术前相比,术后3个月24％ (11/46)的患者神经系统功能发生恶化,有28％(13/46)神经系统功能得到改善.神经心理状态方面,66％(33/50)的患者出院时较术前有不同程度的神经心理学功能退化,但这些退化的功能大多在术后3个月恢复.结论 对于具有合适适应证的胶质瘤患者,行扩大切除术不会造成其生命质量的明显下降,在术后早期会出现神经系统功能和神经心理状态的恶化,但恶化的功能经过一段时间后大多数可恢复至术前水平.%Objective To evaluate the neurological,neuropsychological and quality of life (QOL) alterations in patients who underwent extended resection of gliomas.Methods From January 2014 to November 2015,a total of 58 patients with gliomas were admitted to Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University,and were enrolled into this study.Extended resection was performed in all patients.Patients were assessed at 3 time points,i.e.1 day before surgery (T1),the day of discharge (T2) and 3 months post surgery (T3).National Institutes of Health Stroke Scale (NIHSS) score,Addenbrooke cognitive examination-revised (ACE-R),Hospital Anxiety and Depression (HAD) and neuropsychological test battery (NTB) were used to assess neurological and neuropsychological profiles.QOL was ascertained through the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC-QLQ C30).Results At T1 (58 cases),T2 (50 cases) and T3 (46 cases),the patient's overall QOL score was 67.8 (48.9,86.7),66.7 (47.5,85.9) and 64.8 (41.4,88.5),respectively.There was no significant difference between different time periods (P ＞ 0.05).At T3,24％ (11/46) of the patients showed worsened neurological functions and 28％ (13/46) gained neurological improvement compared with pre-operative conditions.According to the neuropsychological test,65％ (13/50) experienced deterioration of neuropsychological functions to varying degrees.However,those functions recovered at T3 for majority of patients.Conclusions Extended resection of gliomas does not seem to result in deterioration of QOL of patients.Patients undergoing extended resection might experience deterioration of neurological and neuropsychological functions in the early postoperative period,which could recover to preoperative levels after some time in most cases.