脊髓胶质瘤的外科治疗及相关临床问题探讨

发布时间：2018-07-07 21:05

本文选题：脊髓胶质瘤 + 室管膜瘤　；参考：《广东医学》2017年01期

【摘要】：目的对脊髓胶质瘤的外科治疗及其预后进行评价,探讨手术切除程度、放化疗使用及维持脊柱稳定性的相关问题。方法选取在神经外科治疗的61例脊髓胶质瘤病例,其中儿童9例(14岁),成人52例。结合患者临床资料和预后结果,综合分析其外科疗效及相关临床问题。结果病理证实室管膜瘤32例,低级别星形细胞瘤(LGG)20例,高级别星形细胞瘤和胶质母细胞瘤(HGG)9例。本研究随访3~82个月,平均(29.3±23.6)个月,室管膜瘤均全切除,随访期复发6例;LGG全切12例,复发4例;而HGG全切5例,复发3例。采用椎板成形固定27例中,3例随访期间出现脊柱畸形;扩大成形术13例有3例畸形;未行脊柱固定病例中5例出现畸形;而采用后路钉棒系统固定5例均无畸形。结论脊髓胶质瘤治疗存在其特殊性,手术仍应尽可能全切肿瘤,尤其对室管膜瘤和LGG。而术后放疗为首选,HGG可辅用替莫唑胺化疗。切除肿瘤后,针对不同病例应使用相应的脊柱固定术,以维持脊柱稳定性。
[Abstract]:Objective to evaluate the surgical treatment and prognosis of spinal gliomas, and to discuss the degree of surgical resection, the use of radiotherapy and chemotherapy and the maintenance of spinal stability. Methods 61 cases of spinal glioma were treated by neurosurgery, including 9 cases of children (14 years old) and 52 cases of adults. Combined with the clinical data and prognosis of the patients, the surgical efficacy and related clinical problems were comprehensively analyzed. Results 32 cases of ependymoma, 20 cases of low grade astrocytoma (LGG), 9 cases of high grade astrocytoma and glioblastoma (HGG) were confirmed by pathology. The patients were followed up for 3 ~ 82 months (mean (29.3 卤23.6) months). Total resection of ependymoma was performed in 6 cases with LGG in 12 cases, recurrence in 4 cases, and HGG in 5 cases and recurrence in 3 cases. Spinal deformities were found in 3 of 27 cases with laminoplasty, 3 of 13 cases with enlarged angioplasty, 5 of 5 without spinal fixation, and 5 without posterior screw fixation. Conclusion the treatment of spinal glioma has its particularity, and the operation should be as complete as possible, especially for ependymoma and LGG. Postoperative radiotherapy as the first choice of HGG can be supplemented with temozolamide chemotherapy. After tumor resection, spinal fixation should be performed for different cases to maintain spinal stability.
【作者单位】：南方医科大学南方医院神经外科;南方医科大学南方医院神经内科;
【分类号】：R739.42

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