弥散张量成像对胶质瘤手术风险的评估

Objective To elucidate the clinical significance of diffusion tensor imaging (DTI) mainly used for protecting neurological functions in patients with gliomas. Methods Thirty - eight patients with gliomas were recruited to undergo DTI test and assess the status of neurological functions before and after surgery. According to the relationships between gliomas and adjacent white matter(WM) tracts, DTI can be classfied as the following types : type Ⅰ - displacement; type Ⅱ - Infiltration; type Ⅲ - Disruption. The neurological functions before surgery were compared in three groups,as well as the change of neurological functions after surgery was also compared in three groups. Results There were 14 cases in type Ⅰ , 16 cases in type Ⅱ, and 8 cases in type Ⅲ. There were significant difference between DTI types and preoperative neurological functions, as well as between DTI types and the change of postoperative neurological functions ( P < 0. 05 ). Conclusions DTI allows to visualizate the relationships of gliomas and adjacent WM tracts, which represent the different growth patterns of gliomas. It is useful for neurosurgeons to select suitable surgical approaches and determine appropriate extent of resection.     

自拟中药丸剂分型治疗高脂蛋白血症临床研究

我公司９５科研立项，我们从９５年开始研制丸剂治疗高脂蛋白血症，在现代药理研究的基础上结合临床辨证，研制了３种证型的丸剂，进行临床观察，疗效满意，报道如下。临床资料一般资料：观察病例共２８０例，均为本院门诊及住院患者，其中住院病例１０５例，门诊病例１７...     

优势与非优势大脑半球胶质瘤术后功能障碍和生存状况分析

目的分析优势与非优势大脑半球胶质瘤患者手术前后功能和生存状况,为临床治疗考虑提供客观依据。方法回顾性分析外科住院手术治疗、有完整病案记录和随访记录的79例单侧大脑半球胶质瘤患者的资料。用Kaplan-Meier法来评估术后患者的生存状况,KPS评分来对比两组患者随访6个月及12个月的功能状况。结果两组患者手术切除程度、手术后并发症、随访6个月及12个月的功能状况、总体生存状况没有差别。结论优势半球胶质瘤手术后功能障碍和生存状况与非优势半球胶质瘤手术后相比没有差异。因此,肿瘤位于优势或非优势半球不能作为考虑肿瘤切除程度和影响预后的因素。     

杜克大学脑肿瘤中心简介

杜克大学脑肿瘤中心始建于1937年,是全美乃至全球最先开展神经肿瘤诊疗与科研的单位之一。在70多年的历史当中,杜克大学脑肿瘤中心取得令人瞩目的成绩。目前,中心在Darell D．Bigner教授的领导下,杜克脑肿瘤中心正在向着旨在通过多学科合作,改善神经肿瘤患者的预后及生存质量的目标前进。     

颅内原发恶性黑色素瘤综合治疗长期存活1例

颅内原发性黑色素瘤罕见，其预后极差，罕见有长期存活的报道。本文报告1例经综合治疗获得长期存活的桥小脑角恶性黑色素瘤。患者男性．起病初始年龄47岁，主要表现为小脑性共济失调。磁共振显示有侧桥小脑角肿瘤。采取枕下乙状窦后入路，术中处病灶色黑，次全切除肿瘤。病理报告为恶性黑色素瘤。颅外未见原发病灶。术后行四个疗程化疗。3个月后MRI示肿瘤复发，行第二次手术并全切肿瘤。术后予肿瘤疫苗、干扰素、白介素和榄香烯等辅助性治疗。进行了5年的影像学追踪，KPS 100分，无肿瘤复发和转移。     

选择性化疗方案治疗恶性胶质瘤的疗效和生存情况分析

背景与目的：O^6-甲基鸟嘌呤-DNA甲基转移酶（O^6-methylguanine-DNA methyhransferase,MGMT）表达与胶质瘤患者的化疗耐药相关。本研究总结MGMT高表达和低表达恶性胶质瘤患者的化疗方案、近期疗效和生存情况．分析选择性化疗是否对MGMT高表达患者有益。方法：自2000年8月至2006年1月,中山大学肿瘤防治中心神经肿瘤科收治的经手术后病理确诊的成人恶性脑胶质瘤患者57例．所有病例化疗前均有可评价病灶。化疗前用免疫组化方法检测肿瘤组织MGMT表达情况．对MGMT高表达者．尽量避免使用亚硝脲类或替莫唑胺单药化疗,采用不含亚硝脲类或替莫唑胺方案,或由替莫唑胺（temozolomide,TMZ）和顺铂组成联合化疗方案;或亚硝脲类药物、替莫唑胺分别与其他细胞毒药物组成联合化疗方案（VM-26、DDP、CBP、IFO、VP16）;对MGMT低表达者,不限制亚硝脲类药物或替莫唑胺的应用。结果：35例患者MGMT高表达,22例MGMT低表达,MGMT低表达组的客观有效率（objective response,OR）和疾病控制率（response rate,RR）高于MGMT高表达组（40．9％：22．9％和72．7％：60.0%．但差异无统计学意义（P〉0．05）。57例中位随访时间11．7个月（0．7～53．4）。MGMT低表达组和高表达组中位无疾病进展时间（Drogressive-free survival,PFS）分别是8．5个月（95％CI 4．8—19．3）和6．7（95％CI 3．7—9．3）,中位生存时间（overail survival,OS）分别是20．3（95％CI 14．3～）和16．105％CI 11．1～26．2）,中位PFS和0S在MGMT低表达组和高表达组差异无统计学意义（P〉0．05）。结论：在化疗前检测恶性胶质瘤MGMT表达情况,对MGMT高表达患者选用有助于克服耐药的化疗方案进行选择性化疗。可使MGMT高表达患者的近期疗效（客观有效率和疾病控制率）和生存时间（无疾病进展生存和总生存）达到MGMT低表达患者水平。     

中国胶质瘤化疗现状及问题分析

背景与目的:化学治疗目前已成为治疗恶性胶质瘤的标准辅助手段,每年国际上都有大量的相关研究。我国胶质瘤化疗现状如何,尚无文献报道。本文通过中文文献检索及分析,旨在概括我国胶质瘤化疗的现状及存在的问题。方法:检索"CNKI知识网络服务平台-中国期刊全文数据库"、"万方数据知识服务平台(网络版)"及"中华医学会数字期刊"中文数据库中胶质瘤文章,收集发表研究的相关发表信息、患者资料、化疗情况,并将所获得的数据进行汇总分析。结果:本文共检索并纳入210篇胶质瘤化疗文献。基于亚硝脲类化疗药的方案是中国胶质瘤化疗中最常用的方案。替莫唑胺在中国胶质瘤化疗中的应用逐渐增多。中国的化疗文章虽然总病例数较多(总共10105例),但大多为小样本回顾性总结;同时,存在混杂及偏倚,缺乏高质量的前瞻性随机对照研究。结论:我国胶质瘤化疗处于发展阶段,尚有诸多不足,需要改进和提高,特别是规范化化疗和多中心大样本的前瞻性随机对照研究有待加强。     

听神经瘤手术无术中电生理监测40例的面/听神经功能保护

目的 探讨听神经瘤的显微外科手术技巧及术中无电生理监测辅助时的面/听神经功能保护.方法 回顾性分析经影像学检查诊断,应用显微神经外科技术,经枕下-乙状窦后入路行肿瘤切除,术中无电生理监测的40例听神经瘤病例,讨论患者面/听神经功能保护.结果 镜下肿瘤全切38例(95.0%),次全切和大部切除2例(5.0%);术中面神经...     

弥散张量成像对胶质瘤手术风险的评估

Objective To elucidate the clinical significance of diffusion tensor imaging (DTI) mainly used for protecting neurological functions in patients with gliomas. Methods Thirty - eight patients with gliomas were recruited to undergo DTI test and assess the status of neurological functions before and after surgery. According to the relationships between gliomas and adjacent white matter(WM) tracts, DTI can be classfied as the following types : type Ⅰ - displacement; type Ⅱ - Infiltration; type Ⅲ - Disruption. The neurological functions before surgery were compared in three groups,as well as the change of neurological functions after surgery was also compared in three groups. Results There were 14 cases in type Ⅰ , 16 cases in type Ⅱ, and 8 cases in type Ⅲ. There were significant difference between DTI types and preoperative neurological functions, as well as between DTI types and the change of postoperative neurological functions ( P < 0. 05 ). Conclusions DTI allows to visualizate the relationships of gliomas and adjacent WM tracts, which represent the different growth patterns of gliomas. It is useful for neurosurgeons to select suitable surgical approaches and determine appropriate extent of resection.