Wang Junlu,Chen Ruoping,Zhang Li.Application value of IPCNM technique during operations for posterior fossa tumors in children[J].Journal of Clinical Pediatric Surgery,2019,18(12):1023-1030.[doi:10.3969/j.issn.1671-6353.2019.12.008]
IPCNM技术在小儿后颅窝肿瘤手术中的应用价值
- Title:
- Application value of IPCNM technique during operations for posterior fossa tumors in children
- Keywords:
- Cranial Fossa; Posterior/SU; Neoplasms; Surgical Procedures; Operative; Neuroelectrophysiological monitoring; Child
- 分类号:
- R726;R739.41;R741.044
- 摘要:
- 目的 探讨儿童后颅窝肿瘤显微切除术中联合后组颅神经电生理监测（intraoperative posterior cranial nerves monitoring，IPCNM）对后组颅神经功能保护的影响。方法 回顾性收集2012年3月至2015年12月由上海市儿童医院神经外科收治的经CT或MRI证实为后颅窝肿瘤患儿42例作为研究对象。将2012年3月至2013年8月收治的行单纯显微镜下肿瘤切除术的19例后颅窝肿瘤患儿纳入非IPCNM组，2013年9月至2015年12月收治的行显微镜下肿瘤切除过程中联合多模式神经电生理监测的23例后颅窝肿瘤患儿纳入IPCNM组。观察IPCNM组后颅窝肿瘤患儿手术中后组颅神经的实时情况，针对手术的进程给予适当辅助与及时指导；并随访所有后颅窝肿瘤患儿术后后组颅神经功能，分别比较两组间和各组组内后颅窝肿瘤患儿的术前、术后后组颅神经功能恢复情况；同时比较两组后颅窝肿瘤患儿在肿瘤全切率方面的差别。结果 IPCNM组23例后颅窝肿瘤患儿，13例（56.52%）肿瘤全切；非IPCNM组19例后颅窝肿瘤患儿，10例（52.63%）肿瘤全切，差异无统计学意义（χ2=0.098，P=0.752）。同时在术后1周、4周、12周、24周、48周随访后组颅神经功能情况并进行组间和组内比较分析，显示IPCNM组在术后1周和4周与术前比较，差异具有统计学意义（P<0.05）；非IPCNM组在术后1周、4周和12周与术前比较，差异具有统计学意义（P<0.05）；IPCNM组和非IPCNM组在术后1周和4周的后组颅神经功能评估差异具有统计学意义（P<0.05）。结论 在儿童后颅窝肿瘤手术中联合进行多模式的神经电生理监测不仅为手术时避免损伤后组颅神经提供了依据，而且可以有效保护后组颅神经功能，降低并发症发生率和手术风险，缩短术后后组颅神经功能的恢复时间。虽然术中联合电生理监测对于后颅窝肿瘤的切除提出了较为直观的作用，但并没有进一步提高肿瘤全切率。
- Abstract:
- Objective To explore the outcomes of neuroelectrophysiological monitoring plus microsurgical resection of pediatric posterior fossa (PF) tumors on the protection of cranial nerve function.Methods From March 2012 to December 2015,42 hospitalized children with PF tumors as confirmed by computed tomography (CT) or magnetic resonance imaging (MRI) were retrospectively recruited as research subjects.Nineteen cases of PF tumor undergoing simple microscopical resection from March 2012 to August 2013 were classified as non-IPCNM group.And another 23 cases of PF tumor undergoing microscopical resection plus multi-mode neuroelectrophysiological monitoring from September 2013 to December 2015 were designated as IPCNM group.The real-time intra-operative status of posterior cranial nerves was observed for IPCNM group to provide appropriate operative assistance and timely guidance.Cranial nerve functions were followed up.And pre-operative and post-operative recovery of cranial nerve function was compared between two groups and within each group.The inter-group difference of total tumor resection rate was also compared.Results Among them,13/23 cases (56.52%) underwent total tumor resection in IPCNM group versus 10/19 (52.63%) in non-IPCNM group.And the difference was not statistically significant (χ2=0.098,P=0.752).Also cranial nerve function of IPCNM group was compared and analyzed between groups and within groups at 1,4,12,24 and 48 weeks post-operation.And the differences were statistically significant (P<0.05).The differences were statistically significant between non-IPCNM and preoperative groups at 1,4 and 12 weeks post-operation (P<0.05).Statistically significant differences existed in cranial nerve functions between IPCNM and non-IPCNM groups at 1 and 4 weeks post-operation (P<0.05).Conclusion Combined multi-mode neuroelectrophysiological monitoring during operation of pediatric PF tumor not only provides rationales for avoiding the injury of posterior cranial nerve,but also effectively reduces the incidence of complications and surgical risks and shorten the recovery time of posterior cranial nerve function.Although combined intraoperative electrophysiological monitoring has facilitated the resection of PF tumor,it has not further improved its total resection rate.
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备注/Memo
收稿日期:2018-09-29。
基金项目:申康医院发展中心，第一轮促进市级医院临床技能与临床创新三年行动计划（编号：16CR3070B）
通讯作者:张立,Email:zhangl1@children.com.cn