摘要目的 通过术后认知功能评估和术后生存时间探讨额颞胶质母细胞瘤扩大切除术的安全性和可行性.方法 回顾性分析2010年1月至2015年1月额颞叶胶质母细胞瘤患者的临床资料.2012年3月之后的患者实施扩大切除术(试验组,33例),2012年3月之前的患者实施全切术(对照组,28例).随访两组患者生存时间,对两组患者术前、术后蒙特利尔认知评估量表(MoCA)评分行t检验,对患者术后生存时间行多因素Cox模型分析,并绘制生存曲线.结果 对照组术后第7天MoCA评分低于术前[(25.39 ± 3.04)分比(26.67 ± 2.19)分],差异有统计学意义(t=4.446,P<0.05).试验组术后第7天MoCA评分低于术前[(21.93 ± 4.46)分比(23.57 ± 4.04)分],差异有统计学意义(t = 5.542,P<0.05).试验组术后第7天 MoCA 评分低于对照组[(21.93 ± 4.46)分比(25.39 ± 3.04)分],差异有统计学意义(t=3.485,P<0.05).Kaplan-Meier法生存分析显示年龄、手术方式、术前KPS评分差异有统计学意义(P<0.05).Cox模型分析显示手术方式、术前Karnofsky(KPS)评分的危险度分别是0.286、0.965.对照组患者的死亡风险是试验组的0.286倍.试验组生存情况优于对照组.结论 额颞叶胶质母细胞瘤扩大全切术或者全切术,术后患者普遍存在短暂认知功能障碍.额颞叶胶质母细胞瘤扩大全切术安全、有效,可延长患者生存期.

abstractsObjective To evaluate the feasibility and safety of supratotal resection of frontal or temporal lobe glioblastoma by the postoperative cognitive function and overall survival. Methods The clinical data of patients with frontal or temporal lobe glioblastoma and treated from January 2010 to January 2015 were analyzed retrospectively.The patients underwent supratotal resection of glioblastoma after March 2012(trial group, 33 cases). Before March 2012, the patients underwent total resection of glioblastoma(control group,28 cases).The Montreal cognitive assessment(MoCA)scores before operation and the 7th day after operation were used to evaluate the security, while overall survival was used to evaluate the feasibility. Variance analysis of repeated measurement quantitative data was used for the statistical analysis of the results. Multivariate Cox model was used as a method to estimate the independent association of a variable set with overall survival. Survival time observation was plotted by the Kaplan-Meier analysis,starting from the data of surgery.Results The MoCA scores in control group at the 7th day after operation were significantly lower than those before operation:(25.39 ± 3.04)scores vs.(26.67 ± 2.19)scores, t = 4.446,P < 0.05. The MoCA scores in trial group at the 7th day after operation were significantly lower than those before operation:(21.93 ± 4.46)scores vs.(25.39 ± 3.04) scores,t = 3.485,P < 0.05. The survival analysis of Kaplan-Meier method showed that age, surgical method and preoperative KPS scores were statistically significant (P < 0.05). Cox regression analysis showed that the choice of surgical method and preoperative KPS was 0.286 and 0.965,respectively.The risk of death in control group was 0.286 times of that in trial group.The survival time of trial group was better than that of control group.Conclusions The cognitive function of patients with frontal or temporal glioblastoma may have a certain degree of decline after tumor resection or supratotal resection.Supratotal resection could represent a promising strategy that can impact on outcome in glioblastoma patients. Supratotal resection could be a factor influencing survival.