摘要
目的:探究立体定向颅内病变活检术病理诊断及术后出血的影响因素。方法:纳入110例行立体定向颅内病变活检术的患者,根据术后病理结果是否明确分为病理诊断组和病理未诊断组;术后98例患者复查头颅CT,根据术后有无出血征象分为术后出血组和术后未出血组。分别比较术后病理诊断与未诊断组、术后出血与未出血组患者的临床资料及手术相关变量,分析立体定向颅内病变活检术病理诊断率及术后出血的影响因素。结果:110例患者中92例病理结果可以明确诊断,病理诊断率为83.6%。术前影像学定位方式是立体定向颅内病变活检术病理诊断率的影响因素(P<0.05),采用MRI定位患者的病理诊断率较高。凝血酶原时间、国际标准化比值和高级别胶质瘤是术后出血的影响因素(P<0.05),其中高级别胶质瘤是立体定向颅内病变活检术后出血的独立危险因素(OR=5.502,P=0.005),且具有预测价值,敏感度为0.35、特异性为0.914、阳性预测值为0.737、阴性预测值0.671、约登指数为0.264,对应的曲线下面积为0.632(P=0.027)。结论:术前采用MRI定位方式能显著提高立体定向颅内病变活检术病理诊断率;高级别胶质瘤是影响术后出血的独立危险因素。
Objective:To explore the influencing factors for pathological diagnosis rate and postoperative hemorrhage in stereotactic biopsy of intracranial lesions.Methods:A total of 110 patients who underwent ste-reotactic brain lesion biopsy were enrolled.According to whether the pathological results after operation were clearly diagnosed,they were divided into definite pathological diagnosis group and indefinite pathological diag-nosis group.Ninety-eight patients were rechecked by CT after operation and were divided into postoperative hemorrhage group and non-hemorrhage group according to the presence or absence of hemorrhagic signs.The clinical data and surgical related variables of the patients in different groups were compared respectively,and the influencing factors for pathological diagnosis rate and postoperative hemorrhage of stereotactic brain lesion biopsy were analyzed.Results:Pathological diagnosis was made in 92 cases(83.6%).The preoperative imag-ing localization method was the influencing factor for pathological diagnosis of stereotactic brain lesion biop-sy(P<0.05),and the patients with MRI localization had a higher rate of pathological diagnosis.Prothrombin time,international normalized ratio and high-grade glioma were the influencing factors for postoperative hemor-rhage(P<0.05),among which high-grade glioma was an independent risk factor for postoperative hemorrhage af-ter stereotactic brain lesion biopsy(OR=5.502,P=0.005).High-grade glioma has predictive value for hemor-rhage after stereotactic brain biopsy,with sensitivity of 0.35,specificity of 0.914,positive predictive value of 0.737,negative predictive value of 0.671,Youden index of 0.264,and area under curve of 0.632(P=0.027).Conclusion:MRI localization before stereotactic brain lesion biopsy can significantly increase the pathologi-cal diagnosis rate.High-grade glioma is an independent risk factor for postoperative hemorrhage.
作者
钱民伟
任思颖
王丽琨
伍国锋
QIAN Minwei;REN Siying;WANG Likung;WU Guofeng(Clinical Medical School of Guizhou Medical University,Guiyang 550003,China;Department of Emergency,Affiliated Hospital of Guizhou Medical University,Guiyang 550003,China)
出处
《神经损伤与功能重建》
2023年第12期753-758,共6页
Neural Injury and Functional Reconstruction
基金
国家自然科学基金(No.82360253)
贵州医科大学附属医院2021年度院级临床研究课题(No.2021-GMHCT-016)
贵州医科大学附属医院2021年博士科研启动基金项目(No.gyfybsky-2021-30)。
关键词
立体定向颅内病变活检术
病理诊断
术后不良事件
术后出血
影响因素
stereotactic brain biopsy
pathological diagnosis
postoperative adverse events
postoperative hem-orrhage
influencing factor
