恶性脑肿瘤的诊断与治疗特点

Diagnosis and Treatment of Malignant Brain Tumor in Children

目的探讨小儿恶性脑肿瘤的年龄分布特点、肿瘤部位分布、肿瘤性质排序、手术切除程度、病理特点及综合治疗效果。方法回顾性分析经手术治疗的61例恶性脑肿瘤患儿的临床资料,包括恶性脑肿瘤的年龄分布及诊断,依据肿瘤部位不同选择相应的手术入路,局部加全脑照射放疗、三维适形放疗、γ-刀及X-刀等放疗措施。卡氮介(BCNU)、替尼泊苷(VM-26)、替莫唑胺进行化疗方案。结果恶性肿瘤61例。男37例,女24例;平均年龄11.3岁。其中幕上24例,幕下37例。肿瘤行显微镜下全切除、次全切除45例,大部分切除10例,部分切除6例。术后放射治疗39例,占63.9%。化疗29例,占47.5%。随访49例,其中存活27例,死亡22例。结论小儿恶性脑肿瘤的治疗以手术切除为主,根据各个病例的特殊性,制定不同的手术切除方案,术后依据复查头颅CT或MRI结果选择不同的放疗方法,但应有别于成人脑肿瘤。选择适合的病例进行化疗,对于延长小儿的生存期是有效的。

Objective To explore the diagnosis, treatment and pathology of malignant brain tumor in children. Methods The clinical data of 61 children with malignant brain tumor were reviewed, including their age distribution, diagnosis, operation route （ according to the position of the brain tumors）, chemotherapy [ using bischloro - nitrosourea （ BCNU ）, teniposide （ VM - 26） and temozolomide ] and radiotherapy （part and whole brain irradiation,three diamensions eonformal therapy,gamma knife and X -kinfe）. Results Of 61 cases, which including 37 boys and 24 girls whose mean age was 11.3 years,24 cases were supratentorial tumors and 37 cases were infratentorial. Forty -five tumors received total or subtotal recession, 10 cases with major recession,and 6 cases with partial recession. After operation,39 cases （63.9%） received radiotherapy,and 29 cases （47.5%） with chemotherapy. Follow - up of 49 cases were achieved,in which 22 cases died and 27 eases survived. Conclusions Surgical removal is still the chief treatment for malignant brain tumor in children. The exairesis profect should be formulated according to the specificity of each case. Radiotherapy methods should be related to post -operational images（ CT or MRI）. And it was different from the brain tumors in adult. It is good to prolong survival duration for some chosen cases with optimal chemotherapy.