恶性外周神经鞘膜瘤15例临床分析

目的]探讨分析恶性外周神经鞘膜瘤发病特点和临床症状特点.方法]将我院2006年2月至2011年2月神经外科15例头颈部恶性外周神经鞘膜瘤患者为观察组,将同期18例良性头颈部神经纤维瘤患者为对照组.对照组患者均行手术治疗,观察组患者根据病情特点以及一般情况选择姑息手术+化疗或姑息手术+放疗.比较两组间患者肿瘤病灶组织形态学特点、早期临床症状、其他肿瘤合并情况以及生存率.结果]观察组患者肿瘤病灶呈弥散性生长14例(93.33％),平均肿瘤大小(3.6±0.8)cm×(2.0±0.5)cm,病灶陈旧性出血10例(66.57％)明显高于对照组患者肿瘤病灶呈弥散性生长6例(33.33％),平均肿瘤大小(1.7±0.5) cm×(0.9±0.3) cm,病灶陈旧性出血2例(11.11％),差异有显著性(P＜0.05).(2)观察组患者早期临床症状疼痛15例(100％),运动障碍4例(26.67％),感觉障碍6例(40％)明显高于对照组患者早期临床症状疼痛7例(38.89％),运动障碍2例(11.11％),感觉障碍3例(16.67％),差异有显著性(p＜0.05).(3)观察组患者合并听神经瘤6例、脊膜瘤4例、胶质细胞瘤2例,合并率为80％,1年生存率73.33％,5年生存率为6.67％明显异于对照组患者合并听神经瘤1例、脊膜瘤1例、胶质细胞瘤0例,合并率为11.11％,1年生存率100％,5年生存率为97.56％,差异有显著性(P＜0.05).结论]恶性外周神经鞘膜瘤较良性神经纤维瘤起病急,早期临床症状显著,病情发展复杂,治疗愈后不良,因此临床诊断治疗应给予高度重视.

Clinical analysis on 15 cases of malignant peripheral nerve sheath tumor

Objective To explore and analyze the biological characteristics and clinical effect of malignant peripheral nerve sheath tumor. Methods 15 patients with head and neck malignant peripheral nerve sheath tumor in our department were chosen as observation group. 15 patients with head and neck benign neurofibroma were selected as control group. Observation group underwent palliative operation＋ chemotherapy or radiation treatment while control group under- went corresponding operations. The histopathology, early chnical symptom and survival rate were compared in two groups. Results Din observation group, the histopathology such as diffuse growth （14 cases, 93.33%）, average tumor size （3.6 ±0.8cm × 2.0 ± 0.5） and remote hemorrhage （10 cases, 66.57%） were higher than those in control group, with statistical significant differences （P〈 0.05）, the observation group was worse than control group.②The early clinical symptoms such as acute pain, dyskinesia and dysesthesia in two groups had statistical significant differences （P〈 0.05）,the ,3bservation group was much worse than control group.③There were 6 patients having acoustic neurinoma, 4 patients had raeningioma and 2 patients had gliocytoma in observation group, and the 1 year survival rate was 73.33% and 5 year surviva]： rate was 6. 67%. While the 1 year survival rate and 5 year survival rate were 100% and 97.56% respectively in control group. The differences between two groups was obvious and had statistical significance （P 〈 0.05）. Conclusion The malignant peripheral nerve sheath tumor has early obvious clinical symptoms, complicated states of illness, poor prognosis, so enough attention should be paid to its clinical diagnosis.