胸段脊膜瘤显微外科手术疗效分析及手术体会

目的探讨胸段脊膜瘤患者的手术疗效及相关体会。方法回顾性分析2017年1月—2023年11月于联勤保障部队第903医院行显微手术治疗的34例患者的临床资料，分别统计出患者年龄、肿瘤最大横截面、肿瘤是否钙化、二次手术与否、有无进行术后康复等基线资料，同时采用胸段日本骨科协会（JOA）评分评估患者术前、术后出院时及末次随访脊髓神经功能状态；采用辛普森分级评估患者脊膜瘤切除程度并统计分析术后患者功能评分与上述因素关系。结果相关性分析得出术后末次随访JOA与术后康复、二次手术、术前JOA相关（P＜0.05），与年龄、肿瘤最大横截面、肿瘤钙化与否、辛普森分级无关（P＞0.05），进一步使用线性回归分析得出患者术后神经功能改善与术前神经功能状态、二次手术、是否进行术后康复相关（P＜0.05）。结论现代显微神经外科技术能显著改善胸段脊膜瘤患者临床症状，术前脊髓神经功能状态是预后的决定性因素；同时术中完整切除肿瘤，结合后期脊髓功能康复可以使胸段脊膜瘤得到较好的预后。

Objective To explore the surgical efficacy and related experiences of patients with thoracic meningioma. Methods The clinical data of 34 patients treated with microsurgery in the 903rd Hospital of the Joint Logistics Support Force from January 2017 to November 2023 were analyzed retrospectively. The baseline data were calculated such as patient age, maximum cross-sectional area of the tumor, whether the tumor was calcified, whether a second surgery or postoperative rehabilitation had been performed. The thoracic Japanese orthopaedic association（JOA） scores was used to evaluate the spinal cord nerve function status of patients before operation, postoperative discharge and the last follow-up. The extent of meningioma resection was evaluated by Simpson’s gradation, and the relationship between postoperative functional scores and the above factors were analyzed statistically. Results Correlation analysis showed that the last follow-up JOA after surgery was correlated with postoperative rehabilitation, reoperation, and preoperative JOA(P<0.05), but not with age, maximum tumor cross-section, tumor calcification, and Simpson’s grade(P>0.05). Further linear regression analysis showed that postoperative neurological function improvement in patients was related to preoperative neurological function status, reoperation, and whether postoperative rehabilitation was performed(P<0.05). Conclusions Modern microsurgical techniques can significantly improve the clinical symptoms of patients with thoracic meningioma, and preoperative spinal cord nerve function is the decisive factor for prognosis; Simultaneously, complete resection of the tumor during surgery, combined with later spinal cord function rehabilitation, can lead to a better prognosis for thoracic meningioma.