摘要
目的针对传统颅底占位手术四级分类体系无法精准反映手术难度差异的问题,本研究旨在建立并验证基于多维度指标的颅底肿瘤手术难度分级方案,以指导临床决策与资源优化。方法基于我院2018年131例颅底占位手术病例,采用自研的“颅底肿瘤手术难度分级方案”(肿瘤累及区域、累及动脉、累及静脉、累及神经等9大评分维度),将手术难度分为Ⅰ~Ⅳ级,分析各组基线资料、影像学特征、手术指标及术后结局,验证量表的临床适用性。结果Ⅰ~Ⅳ级手术难度逐级递增,累及区域、动脉、神经等核心维度评分差异有统计学意义(P<0.05)。随难度等级升高,术中输血率(0→38.1%)、手术时长[(1.6±1.5)小时→(7.3±4.2)小时]、住院时间[(7.6±2.7)天→(15.9±15.2)天]及术后并发症(15.5%→52.4%)均显著增加,差异有统计学意义(P<0.05)。结论该体系通过量化评估实现手术难度梯度分级,弥补传统四级分类的不足,为个性化手术入路选择、DRG精细化付费及医师培训提供科学依据,推动颅底亚专业规范化发展。
Objective Traditional classification systems for skull base lesion surgeries fail to accurately reflect the differences in surgical difficulty.This study aims to establish and validate a multi-dimensional grading sclae for skull base tumor surgical difficulty,to guide clinical decision-making and resource optimization.Methods A total of 131 patients with skull base tumors who underwent surgery at West China Hospital of Sichuan University in 2018 were included in this study.Based on the self-developed“grading scheme for surgical difficulty of skull base tumors”(encompassing nine dimensions such as involved regions,arteries,nerves,and tumor characteristics),patients were categorized into gradesⅠ-Ⅳ.The baseline data,imaging features,surgical indicators and postoperative outcomes of each group were analyzed to verify the clinical applicability of the scale.Results The surgical difficulty increased progressively from gradeⅠtoⅣ,with significant differences observed in core dimensions such as involved regions,arteries,and nerves(all P<0.05).As the difficulty level increased,the intraoperative blood transfusion rate(0→38.1%),operation time[(1.6±1.5)h→(7.3±4.2)h],hospital stay[(7.6±2.7)d→(15.9±15.2)d],and postoperative complication rates(15.5%→52.4%)also increased significantly(all P<0.05).Conclusion This system enables quantitative evaluation-based surgical difficulty gradient classification,compensating for the limitations of the traditional classification system.It provides a scientific foundation for personalized surgical approach selection,DRG-based fine payment,physician training,and promotes the standardized development of the skull base subspecialty.
作者
吴多路
王跃龙
黄涛
陈虹旭
梁锐超
张扬
陈超越
潘才厚
全华艳
刘志勇
刘翼
刘浩
昝昕
徐建国
WU Duolu;WANG Yuelong;HUANG Tao;CHEN Hongxu;LIANG Ruichao;ZHANG Yang;CHEN Chaoyue;PAN Caihou;QUAN Huayan;LIU Zhiyong;LIU Yi;LIU Hao;ZAN Xin;XU Jianguo(Department of Neurosurgery,West China Hospital of Sichuan University,Chengdu 610041,China;不详)
出处
《临床外科杂志》
2025年第11期1137-1142,共6页
Journal of Clinical Surgery
基金
国家自然科学资金面上项目(82173175)
四川省科技计划重点研发项目(2023YFS0105)
四川省科技计划重点研发项目(2023YFS0013)
四川大学住院医师科研基金/专科医师科研基金。
关键词
颅底肿瘤
评分
手术难度
神经外科
分级
skull base neoplasms
grading
surgical difficulty
neurosurgery
classification
