脑胶质瘤的显微手术治疗——附183例报告

Microsurgical Technique of Brain Glioma——A Report of 183 Cases

背景与目的:脑胶质瘤预后差,手术为其主要治疗措施,切除程度与预后相关。本研究探讨显微外科手术对脑胶质瘤的切除程度、术后患者的生存质量及生存时间的作用。方法:回顾性分析采用显微手术治疗的183例脑胶质瘤患者临床资料,对显微手术方法进行总结并分析肿瘤切除程度、术后患者身体机能状况评分(karnofskyperformancescale,KPS)及生存情况。针对脑胶质瘤生长部位采用不同的显微手术方法。非功能区肿瘤沿周边水肿带分离,整块切除,用大功率双极电凝;功能区肿瘤沿皮层脑沟分离,先切除瘤中心部分,再切除周围部分,用小功率电凝;重要血管区肿瘤沿血管生长方向吸除肿瘤,尽量避免电凝。结果:资料完整者共183例,其中非功能区肿瘤85例,功能区肿瘤47例,重要血管区肿瘤51例。本组显微手术全切及次全切除者89.1%(163/183);术后KPS评分平均74分,其中23例较术前平均下降10.2分,44例较术前平均提高8.6分,余116例同术前。随访时间12～216个月,平均47.8个月,随访率100%。生存期:以末次随访日期为终点,共有113例星形细胞瘤患者得到长期随访(≥5年),其中低分级星形细胞瘤5年生存率为75.4%(52/69),高分级星形细胞瘤5年生存率为18.2%(8/44)。结论:根据脑胶质瘤生长部位不同,灵活运用不同的显微手术方法,可达到在保护神经功能?

BACKGROUND &OBJECTIVE: Prognosis of glioma is still poor, its main treatment is surgery. The extent of tumor resection relates with prognosis. This study was to evaluate the extent of resection, post operative Karnofsky performance scale (KPS), and survival rate of the glioma patients received microsurgery. METHODS: Records of 183 glioma patients received microneurosurgery were retrospectively analyzed, the extent of resection, post operative KPS, and survival rate of patients were evaluated. Different microsurgical techniques were applied according to the location of gliomas. En bloc resection was performed for gliomas in non functional areas by dissecting the tumors along edema area with high power bipolar electrocoagulation. The tumors in functional areas were separated along cortex sulcus, the central part of tumor was removed firstly, and residual part was resected with low power electrocoagulation. Gliomas close to important vessels were sucked, and electrocoagulation seldom performed. RESULTS: Among 183 cases of glioma, 85 in non functional area, 47 in functional area, and 51 close to important vessels. Total and sub total resection was performed in 163 patients (89.1%). The average post operative KPS was 74. The KPS was decreased in 23 patients, increased in 44 patients, and stable in 116 patients. Patients were followed up for 12 216 months with an average of 47.8 months. The follow up rate was 100%. Among 113 patients with long term follow up (≥5 years), 5 year survival rates of low grade, and high grade astrocytoma patients were 75.4%(52/69), and 18.2%(8/44). CONCLUSION: Using different microsurgical patterns according to location of glioma, maximal resection of tumor may achieve with protection of neurological function.