颅内血管外周细胞瘤的临床特点与治疗

发布时间：2018-07-29 05:45

【摘要】：目的:研究颅内血管外周细胞瘤的预后相关因素,以便更好地理解该疾病并指导临床诊疗。方法:1、病例资料:从2008年1月至2016年12月,共21例血管外周细胞瘤病人于山东大学齐鲁医院神经外科接受手术。资料收集包括病人的临床表现、影像学资料、手术处理情况、病理报告及随访预后等,采用回顾性病例研究方法。2、手术治疗:所有病人均接受了外科手术,部分病人术后接受了放疗及同步化疗。3、病理检查:所有肿瘤标本均经过石蜡切片后行HE染色及免疫组化染色。病理诊断依据来自于2007年WHO公布的中枢神经系统肿瘤分类。4、随访:所有病人均于术后及随访时行脑CT或MRI证实手术效果及是否复发。5、统计学分析:利用Kaplan-meier单因素生存分析判断相关因素对病人预后及随访期内复发情况的影响。结果:这组病人在性别发生率上无明显差异,年龄从26岁至70岁,病程持续时间从6天至21年。无特异性临床表现,但以颅内高压及视力影响为主。肿瘤在影像学上信号不等或混杂信号,可见囊实性改变,形状可不规则,直径从1.5至7厘米不等。肿瘤主要分布于凸面及镰窦旁,也可分布于颅底。手术入路根据肿瘤位置而定。随访时间从12个月至108个月不等。Simpson Ⅰ级切除共9例,其中2例病人在随访期间复发;Simpson Ⅱ级切除共5例,3例复发;SimpsonⅢ及以上级别切除共7例,随访期间均复发,差异具有显著性(p=0.0020.05)。Ki-67小于5的病例复发率明显低于Ki-67大于5的病例(p=0.0190.05)。统计学单因素分析认为肿瘤切除程度及Ki-67是肿瘤的复发及预后相关因素,但多因素分析认为只有肿瘤切除程度密切相关;而结合临床实际情况及本组数据考虑,我们认为肿瘤切除程度、Ki-67均可能与复发情况相关。结论:手术全切除是治疗颅内血管外周细胞瘤的首选措施,肿瘤切除程度及Ki-67指数是影响预后的主要因素。肿瘤SimpsonⅡ级及以上切除、Ki-67大于5,是血管外周细胞瘤患者容易复发及预后不良的危险因素。首次手术即做到Simpson Ⅰ级切除是减少血管外周细胞瘤复发的重要环节。
[Abstract]:Objective: To study the prognostic factors of intracranial vascular peripheral cytoma, so as to better understand the disease and guide clinical diagnosis and treatment. Method: 1, case data: from January 2008 to December 2016, 21 cases of peripheral blood peripheral cell tumor were received surgery in Department of Neurosurgery, Qilu Hospital of Shandong University. Data collection included the clinical manifestation and image of patients. Study data, surgical treatment, pathological report and follow-up prognosis, using retrospective case study method.2, surgical treatment: all patients received surgery, some patients received radiotherapy and synchronous chemotherapy.3, pathological examination: all the tumor specimens were stained with HE staining and immunohistochemical staining after paraffin section. Pathological diagnosis According to the central nervous system tumor classification.4 published in 2007 WHO, all patients were followed up and followed up with CT or MRI to confirm the effect and relapse of.5. Statistical analysis: the effect of Kaplan-meier single factor survival analysis to determine the effect of related factors on the recurrence of the patients during and during the follow-up period. There was no significant difference in the incidence of sex between 26 and 70 years. The duration of the course was from 6 to 21 years. There was no specific clinical manifestation, but intracranial hypertension and visual acuity were the main factors. The tumors were unequal or mixed signals in imaging, visible changes in the capsule, irregular shape, from 1.5 to 7 cm in diameter. A total of 9 cases of.Simpson I resection ranged from 12 months to 108 months, of which 2 patients relapsed during follow-up; 5 cases of Simpson II resection and 3 recurrence; Simpson III and 7 cases were excised by upper level, and the recurrence was different during the follow-up period, the difference was all the difference during the follow-up period. The recurrence rate of cases with significant (p=0.0020.05).Ki-67 less than 5 was significantly lower than that of Ki-67 greater than 5 (p=0.0190.05). Statistical univariate analysis suggested that tumor resection degree and Ki-67 were related factors for tumor recurrence and prognosis, but multivariate analysis believed that only tumor resection was closely related; combined with clinical practice and this group According to the data, we think the degree of tumor resection and Ki-67 may be related to the recurrence. Conclusion: total resection is the first choice for the treatment of intracranial vascular peripheral cell tumor. The degree of tumor resection and the Ki-67 index are the main factors affecting the prognosis. The tumor Simpson grade II and above resection, Ki-67 greater than 5, is the volume of the patients with peripheral blood cell tumor. Risk factors for recurrence and poor prognosis are the first step of Simpson grade I resection, which is an important step to reduce the recurrence of hemangioma.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41

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