268例儿童脑肿瘤的临床及病理特点分析

  目的  探讨儿童脑肿瘤的诊治经验, 以利于早期诊断、合理治疗、改善预后。  方法  对2005年7月~2010年7月间重庆医科大学附属儿童医院神经外科收治的268例儿童脑肿瘤进行回顾性分析。  结果  268例儿童脑肿瘤中病理类型前5位依次是: 星形细胞瘤87例(32.5%), 髓母细胞瘤50例(18.7%), 室管膜瘤42例(15.7%), 颅咽管瘤32例(12.0%), 生殖细胞肿瘤14例(5.4%)。主要临床表现为头痛、呕吐、肢体瘫痪、步态不稳、抽搐、视力下降, 其中首诊误诊率达19.8%。肿瘤全切230例(85.8%), 次全切29例(10.8%), 大部分切除6例(2.4%), 254例术后治愈出院。术后放射治疗109例, 占手术病例的40.6%;化疗55例, 占手术病例的20.5%。  结论  儿童脑肿瘤临床表现不典型, 病程较长, 误诊率较高, 头颅CT和MRI是诊断的首选方法。手术为治疗首选, Ommaya储液囊外引流治疗脑肿瘤梗阻性脑积水效果较肯定。术后进行放化疗, 对于延长儿童的生存期有效。 

Clinical and Pathological Patterns of Brain Tumors in Children

  Objective  To explore previous experiences in the diagnosis and treatment of brain tumors in children to assist in early diagnosis and in obtaining reasonable treatment and improving prognosis.  Methods  A total of 268 brain tumor cases admitted into the Children's Hospital of Chongqing Medical University from July 2005 to July 2010 were analyzed retrospectively.  Results  The top five tumors were astrocytoma (87cases, 32.5%), medulloblastoma (50 cases, 18.7%), ependymoma (42 cases, 15.7%), craniopharyngioma (32 cases, 12.0%), and germinoma (14 cases, 5.4%). The main clinical manifestations were vomiting, headache, paralysis of limbs, instability of gait, convulsion, and impaired vision. Fifty-three cases (19, 8%) were misdiagnosed. Total resection was achieved in 230 cases (85.8%), whereas subtotal resection and partial resection were achieved in 29 cases (10.8%) and 6 cases (2.4%), respectively. Clinical cure was attained in 254 cases. After operation, 109 (40.6%) received radiotherapy and 55 (20.5%) received chemotherapy.  Conclusion  Children's brain tumors have atypical clinical manifestations and longer courses. Misdiagnosis of children's brain tumors is a common phenomenon. Brain MRI and CT are the initial choices in the diagnosis. Surgical resection is the first selection to cure brain tumor in childhood. The Ommaya pump produces good result in the treatment of acute obstructive hydrocephalus. After operation, individual radiotherapy and chemotherapy are helpful for longer survival.