作者：张恒，陶胜忠，刘展，马帅

单位：

郑州大学第二附属医院神经外科

单位（英文）：

DepartmentofNeurosurgery,theSecondAffiliatedHospitalofZhengzhouUniversity,Zhengzhou450014,China

关键词：

脑膜瘤; 术后瘤周水肿; 水肿指数; 三维重建; 3D-Slicer;

关键词（英文）：

Meningioma;Postoperativeperitumoralbrainedema;Edemaindex;Three-dimensionalreconstruction;3D-Slicer

中图分类号：

R739.45

DOI：

10.12114/j.issn.1008-5971.2023.00.077

基金项目：

2020年河南省医学教育研究项目( Wjlx2020086?)

摘要：

目的 探讨3D-Slicer软件在脑膜瘤患者发生术后瘤周水肿（PTBE）加重评估中的应用价值。方法回顾性选取2020年10月至2022年6月于郑州大学第二附属医院神经外科接受手术治疗的脑膜瘤患者129例，将发生术后PTBE加重的患者作为术后PTBE加重组（n=37），其余患者作为无术后PTBE加重组（n=92）。比较两组年龄、性别、术前水肿指数（EI）、肿瘤体积、Ki-67、术中引流静脉受损情况、肿瘤良恶性情况、癫痫发作情况。采用多因素Logistic回归分析探讨脑膜瘤患者发生术后PTBE加重的影响因素。采用ROC曲线评估术前EI和肿瘤体积对脑膜瘤患者发生术后PTBE加重的预测价值。结果 术后PTBE加重组术前EI低于无术后PTBE加重组，肿瘤体积大于无术后PTBE加重组，Ki-67、术中引流静脉受损者占比高于无术后PTBE加重组（P<0.05）。多因素Logistic回归分析结果显示，术前EI升高、肿瘤体积增大、Ki-67升高是脑膜瘤患者发生术后PTBE加重的危险因素，术中引流静脉未受损是脑膜瘤患者发生术后PTBE加重的保护因素（P<0.05）。ROC曲线分析结果显示，术前EI及肿瘤体积预测脑膜瘤患者发生术后PTBE加重的AUC分别为0.83[95%CI(0.77,0.90)]、0.80[95%CI(0.73,0.88)]，最佳截断值分别为123%、24.5 cm3，灵敏度分别为83.8%、75.7%，特异度分别为73.9%、65.2%。结论 术前EI升高、肿瘤体积增大、Ki-67升高是脑膜瘤患者发生术后PTBE加重的危险因素，而术中引流静脉未受损是脑膜瘤患者发生术后PTBE加重的保护因素，且术前EI及肿瘤体积对脑膜瘤患者发生术后PTBE加重有较好的预测价值。未来可借助3D-Slicer软件评估脑膜瘤患者术前EI及肿瘤体积以预测术后PTBE加重发生风险，进而对患者进行个体化干预。

英文摘要：

ObjectiveToinvestigatetheapplicationvalueof3D-Slicersoftwareintheevaluationofpostoperativeperitumoralbrainedema(PTBE)aggravationinpatientswithmeningioma.MethodsAtotalof129patientswithmeningiomawhoreceivedsurgicaltreatmentintheDepartmentofNeurosurgery,theSecondAffiliatedHospitalofZhengzhouUniversityfromOctober2020toJune2022wereretrospectivelyselected.PatientswithpostoperativePTBEaggravationwereclassifiedaspostoperativePTBEaggravationgroup(n=37),andtheotherswereclassifiedasnopostoperativePTBEaggravationgroup(n=92).Age,gender,preoperativeedemaindex(EI),tumorvolume,Ki-67,intraoperativedrainageveindamage,benignandmalignanttumor,andepilepticseizurewerecomparedbetweenthetwogroups.MultivariateLogisticregressionanalysiswasusedtoinvestigatetheinfluencingfactorsofpostoperativePTBEaggravationinpatientswithmeningioma.ROCcurvewasusedtoevaluatethepredictivevalueofpreoperativeEIandtumorvolumeforpostoperativePTBEaggravationinpatientswithmeningioma.ResultsThepreoperativeEIofpostoperativePTBEaggravationgroupwaslowerthanthatofnopostoperativePTBEaggravationgroup,tumorvolumewaslagerthanthatofnopostoperativePTBEaggravationgroup,Ki-67andtheproportionofpatientswithintraoperativedrainageveindamagewerehigherthanthoseofnopostoperativePTBEaggravationgroup(P<0.05).TheresultsofmultivariateLogisticregressionanalysisshowedthatincreasedpreoperativeEI,tumorvolumeandKi-67wereriskfactorsforpostoperativePTBEaggravationinpatientswithmeningioma,andnointraoperativedrainageveindamagewasprotectivefactorforpostoperativePTBEaggravationinpatientswithmeningioma(P<0.05).ROCcurveanalysisresultsshowedthattheAUCofpreoperativeEIandtumorvolumeforpredictingpostoperativePTBEaggravationinmeningiomapatientswas0.83[95%CI(0.77,0.90)]and0.80[95%CI(0.73,0.88)],theoptimalcut-offvaluewas123%and24.5cm3,thesensitivitywas83.8%and75.7%,andthespecificitywasand73.9%and65.2%,respectively.ConclusionTheincreasedpreoperativeEI,tumorvolumeandKi-67areriskfactorsforpostoperativePTBEaggravationinpatientswithmeningioma,andnointraoperativedrainageveindamageisaprotectivefactorforpostoperativePTBEaggravationinpatientswithmeningioma,andpreoperativeEIandtumorvolumehavegoodpredictivevalueforpostoperativePTBEaggravationinpatientswithmeningioma.Inthefuture,3D-SlicersoftwarecanbeusedtoevaluatepreoperativeEIandtumorvolumeofmeningiomapatientstopredicttheriskofpostoperativePTBEaggravation,soastocarryoutindividualizedinterventionforpatients.

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