肿瘤切除程度及术后放、化疗对脑胶质瘤疗效影响的临床研究

目的探讨肿瘤切除程度的不同及术后不同辅助治疗方法对脑胶质瘤疗效的影响。方法对319例临床资料完整的脑胶质瘤患者进行回顾性研究，分别从肿瘤切除程度及术后辅助治疗方法两个方面探讨对低分级胶质瘤和高分级胶质瘤治疗效果的影响。根据随访结果确定1、3、5年生存率，采用Х^2检验对组间生存率差异进行比较分析。结果低分级胶质瘤患者：肿瘤全切组与未全切组1、3、5年生存率差异无显著性意义；术后早期放疗组较延期放疗组1年生存率差异无显著性意义，3、5年生存率降低。其差异有显著性意义。高分级胶质瘤患者：肿瘤全切组较未全切组1、3、5年生存率高。其差异有显著性意义；术后放、化联合治疗组较单纯放疗组1、3、5年生存率高。其差异有显著性意义。结论手术治疗脑胶质瘤。对于低分级胶质瘤应在保留重要神经功能的前提下切除肿瘤，高分级胶质瘤应尽可能扩大切除；低分级胶质瘤术后应延期行放疗，以肿瘤复发或生长增快时为宜，高分级胶质瘤术后采用放、化联合治疗较单纯放疗更为有效。

Effect of resection extent and postoperative radiotherapy and chemotherapy on the prognosis of patients with brain glioma

Objective To compare the curative effects of the patients with brain gliomas who have different resection extents and postoperative adjunctive therapies. Methods Integrated clinical data of 319 cases of brain glioma were analyzed retrospectively. According to the follow-up results, 1-, 3-, and 5-year survival rates of these patients (low-grade glioma and high-grade glioma) were compared between total removal and partial removal groups and between early and delayed radiotherapy groups and between simple radiotherapy and combined radio-/chemotherapy groups. Results Low-grade glioma: No significant difference in the 1-, 3-, and 5-year survival rates was found between total removal and partial removal groups; the 1 -year survival rate of early radiotherapy group was not different from that of delayed radiotherapy group, but the 3-, 5-year survival rates were significantly lower. High-grade glioma: The 1-, 3-, and 5-year survival rates of total removal group were higher than those of partial removal cases; the 1-, 3-, and 5-year survival rates of combined radio-/chemotherapy group were higher than those of simple radiotherapy group. Conclusion During the surgeries for brain gliomas, the surgeons should remove the high-grade tumors as much as possible and reserve the important verve functions when removing the low-grade tumors. The proper time of radiotherapy for low-grade gliomas is the moment when the gliomas relapse or grow faster, and as for high-grade gliomas the combined radio-/chemotherapy should be carried out as early as possible.