胼胝体胶质瘤的显微手术及综合治疗策略
Journal Title: Di-er Junyi Daxue Xuebao - Year 2009, Vol 30, Issue 4
Abstract
目的:探讨胼胝体胶质瘤的临床特点、显微手术可行性和术后综合治疗策略以改善预后。方法：回顾性分析1995年1月至2007年12月我院收治的82例胼胝体胶质瘤患者的临床特点、诊治经过及预后。术前根据影像特点选择最佳手术入路和切除的策略。术中应用神经导航8例，B超监测4例，超声吸引手术刀(CUSA) 辅助切除肿瘤5例。术后病理学证实为胶质瘤且级别Ⅱ级以上者行放化疗。化疗方案：替尼泊苷（VM-26）+甲环亚硝脲（Me-CCNU）和(或)替莫唑胺。放疗方案：根据病理级别和胶质瘤范围，以普通外照射为主要方式进行个体化设定。采用门诊、电话及邮件等方式进行随访。结果：82例患者临床表现为头痛、呕吐44例，癫16例，精神症状12例，记忆力减退10例，轻偏瘫20例。显微手术经纵裂入路44例，经皮质入路24例，经纵裂-皮质联合入路5例，活检7例，仅放化疗2例。术中见肿瘤主体位于胼胝体嘴部6例，膝部36例，体部30例，压部10例；镜下全切除45例，次全切除13例，部分切除15例，活检7例。病理证实为星形胶质细胞瘤48例，少突胶质细胞瘤11例，室管膜瘤2例，胶质母细胞瘤19例。获得随访61例，临床症状改善45例，无明显变化9例，加重7例；1年生存率为89%，2年71%，3年62%，5年39%，最长生存期140个月，中位生存时间47个月。COX生存分析提示年龄大、肿瘤病理级别高、切除不完全是预后较差的相关因素。结论：胼胝体胶质瘤是位置特殊的肿瘤，术前应充分了解肿瘤解剖位置、毗邻关系、血供等，正确的手术入路和策略可降低致残率并取得良好疗效，经纵裂入路是常用入路，神经导航、术中超声监测结合显微技术可提高肿瘤切除程度和减少损伤及改善预后。
Authors and Affiliations
Ju-xiang CHEN , Yi-cheng LU , Tao XU , Ke-hua SUN , Guo-han HU , Chun LUO , Ming-kun YU , Chun-lin WANG , Li-quan LU, Yong YAN
Keywords
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