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目的从认知功能的角度探讨额叶胶质瘤扩大切除手术的可行性及安全性。方法回顾性分析北京天坛医院神经外科自2014年9月至2015年12月间收治的66例额叶胶质瘤患者的临床资料。所有患者均由同一术者完成肿瘤扩大切除。依据胼胝体是否受到侵犯将患者分为2组,分别采用蒙特利尔认知评估量表对患者术前、术后7d及术后14d的认知状况进行评估。结果 66例患者的术前、术后7 d、14 d的蒙特利尔认知评分分别为25.88±2.33、22.06±2.27、25.35±2.32分,手术前后不同时间蒙特利尔认知评分的差异有统计学意义(F=71.793,P=0.000)。在未侵犯胼胝体组和侵犯胼胝体组,同组手术前后不同时间蒙特利尔认知评分的差异均有统计学意义(P均<0.05);同组术前和术后7 d、术后7 d和术后14 d的蒙特利尔认知评分的差异有统计学意义(P=0.000),术前和术后14 d评分差异则无统计学意义(侵犯胼胝体组P=0.066,未侵犯胼胝体组P=0.653)。结论额叶胶质瘤患者在接受肿瘤扩大切除术后,认知功能会有一定程度的下降。但是,经过一段时间的恢复,可以达到术前水平。从认知功能的角度考虑,额叶胶质瘤扩大切除手术是安全、可行的。
Objective To explore the feasibility and safety of enlarged resection of frontal glioma from the perspective of cognitive function. Methods The clinical data of 66 patients with frontal glioma admitted to Department of Neurosurgery, Beijing Tiantan Hospital from September 2014 to December 2015 were retrospectively analyzed. All patients were completed by the same surgeon tumor excision. The patients were divided into two groups according to whether the corpus callosum was infringed or not, and the cognition status of the patients before operation, 7 days after operation and 14 days after operation were assessed by Montreal Cognitive Assessment Scale. Results The Montreal Cognitive Score of preoperative, postoperative 7 and 14 days were 25.88 ± 2.33, 22.06 ± 2.27 and 25.35 ± 2.32, respectively. There were significant differences in Montreal Cognitive Score at different time points before and after operation ( F = 71.793, P = 0.000). There were significant differences in Montreal Cognitive Scores between the same group before and after operation (P <0.05). In the same group before operation and 7 days after operation, and on the 7th day after operation There was a significant difference in Montreal Cognitive Score between the 14th day and the 14th day after operation (P = .066 for the corpus callosum group and P = .653 for the noninvasive corpus callosum group) . Conclusion In patients with frontal gliomas, the cognitive function may decline to a certain degree after receiving tumor expansion resection. However, after a period of recovery, you can reach the preoperative level. From the perspective of cognitive function, enlarged frontal lobe glioma resection is safe and feasible.