311例脑干胶质瘤的临床特征与手术治疗

目的进一步了解脑干胶质瘤的临床特征、诊疗方法和手术效果.方法回顾性分析我院经手术治疗的311例脑干胶质瘤患者的临床表现、肿瘤影像学特点及生长模式和手术治疗效果.结果脑干不同位置、不同类型胶质瘤生长模式不尽相同.全组患者肿瘤手术全切率为40.5%,近全切率为29.9%,部分切除率为29.6%;术后好转、稳定者占72.4%,恶化及出现新体征者占27.6%;手术死亡率约为1.3%.室管膜瘤患者术后5年生存率为67%;星形细胞瘤为42%,其中间变性星形细胞瘤为14%;胶母细胞瘤无1例生存超过5年.结论脑干胶质瘤的组织学类型和对脑干的侵及存在差异.手术对局限性分化良好的胶质瘤疗效满意,甚至可以治愈,并可帮助一些恶性胶质瘤患者暂时缓解症状,为综合治疗创造条件.

Surgical management of brain-stem gliomas: a retrospective analysis of 311 cases

Objective To further study the clinical features, diagnosis, and surgery outcome of brain-stem gliomas. Methods Totally 311 patients with brain-stem gliomas received surgery operations in our hospital from 1980 to the end of 2001. The clinical data, neuroimages, growth patterns, and operative feasibility were analyzed. Results Different brain-stem gliomas showed different growth patterns. In this series, total excision rate of the tumor was 40.5%, subtotal 29.9%,partial 29.6%, and operative mortality 1.3%. Among 311 patients, 72.4% patients had been improved and stable in their symptoms after operation, and 27.6% deteriorated or having transitory new signs. Five years survival rate is 67% in ependymoma patients, 42% in astrocytoma patients. None of brain-stem glioblastoma patients survived up to 5 years. Conclusions The histology and growth pattern of brainstem gliomas varies. The patients with well-differentiated gliomas of brain-stem may be cured by microsurgical removal. For malignant ones, partial removal may prolong survival and facilitate the following combined therapy.