视神经胶质瘤的治疗及预后分析

目的探讨视神经胶质瘤(optic pathway glioma,OPG)的治疗及预后情况。方法对我院收治的OPG56例进行不同入路的显微外科切除术,其中13例术后行放射治疗,放射治疗的总剂量45～60 Gy,评价患者术后9个月视力、视野与全身恢复情况及临床、病理因素与预后的关系。结果术后病理检查结果显示毛细胞型星形细胞瘤40例,星形细胞瘤13例,多形性胶质母细胞瘤3例。术后9个月视力明显提高者占91.1%,视野缺损改善者占94.6%,伴颞、额部头痛者症状均消失,下丘脑功能损伤明显恢复者占94.3%。术后12个月,肿瘤复发率为5.3%。14岁以下OPG患者术后复发率明显低于14岁以上OPG患者,视力恢复及视野缺损改善明显优于14岁以上OPG患者,二者比较差异均有统计学意义(P0.05);多形性胶质母细胞瘤术后复发率明显高于毛细胞型星形细胞瘤及星形细胞瘤,视力恢复及视野缺损改善均差于毛细胞型星形细胞瘤及星形细胞瘤,差异亦均有统计学意义(P0.05)。结论早期手术切除联合术后放射治疗可明显改善OPG患者的预后,但是对于多形性胶质母细胞瘤的治疗效果改善不明显。

Analysis on Therapy and Prognosis of Optic Pathway Gliomas

Objective To explore the treatment and prognosis of optic pathway gliomas （ OPG） . Methods 56 pa-tients with OPG in our hospital were treated by microsurgical treatment, and 13 patients received appropriate postoperative ra-diation therapy with general total dose of 45-60 Gy. All patients were followed up for 9 months to evaluate visual field and a-cuity and systemic therapeutic effect, and analyze the possible relationship between the postoperative prognosis and the clinico-pathological factors of OPG. Results Pathological examination showed that there were 40 patients with pilocytic astrocytoma, 13 with astrocytoma and 3 with pleomorphic neuroblastoma. The 9-month follow-up results after operation showed 91. 1% of patients with improvement of vision, 94. 6% with recovery of defect of field vision, and headache in forehead and temple dis-appeared. Out of 35 cases of hypothalamus injury, 94. 3% showed marked progress. The tumor recurrence rate was 5. 3%during 12 months of follow-up. The chi-square test showed that：the recurrence rate of the OPG was significantly lower in pa-tients under the age of 14 than that in patients elder than 14-year-old group, and the differences of recovery of visual acuity and improvement of visual field defect were significant between the two groups （P〈0. 05）; the same phenomenon could be observed in histo-pathological examination which recurrence rate of pleomorphic neuroblastoma was significantly higher than that of other two kinds of pilocytic glioma, and the differences of recovery of visual acuity and improvement of visual field de-fect were also significant （P〈0. 05）. Conclusion Microsurgical resection combined with postoperative radiotherapy in treat-ment of OPG can improve patient＇s prognosis significantly, but the effect is not obvious in pleomorphic neuroblastoma.