不同年龄组多节段髓内肿瘤患者的诊治分析

Analysis on the diagnosis and treatments of multi-segmental intramedullary spinal cord tumors in different age group

目的分析不同年龄组多节段髓内肿瘤的性质、部位、肿瘤切除程度和患者预后等特点。方法前瞻性分析2002年1月至2009年12月我院收治的78例多节段(≥3个椎体节段)髓内肿瘤患者的资料,以18周岁为界分为未成年组和成年组。77例患者行后正中入路显微镜下肿瘤切除术,术中测量肿瘤的实际长度,HE和免疫组化染色确定肿瘤性质和分级,以IJOA评分评估患者神经功能状况,IJOA分值差(术后IJOA-术前IJOA)判定患者近期预后。采用SPSS17.0统计软件对资料进行统计学分析。结果两组患者的平均住院天数、手术前后IJOA评分、肌力、二便状况以及肿瘤部位、节段数、长径、切除程度等无显著性差异。肿瘤性质:未成年组以偏良性胶质瘤(6例,40%)和先天性肿瘤(6例,40%)多见;成年组以室管膜瘤(29例,46%)多见,有显著性差异(Z=-2.13,P=0.03)。未成年组患者近期预后相对较好,与成年组比较有显著性差异(Z=-2.06,P=0.04)。结论多节段髓内肿瘤在未成年患者中以偏良性胶质瘤(星形细胞瘤Ⅰ-Ⅱ级)和先天性肿瘤多见,成年患者中以室管膜瘤居多;未成年组患者近期预后相对较好。

Objective To compare and analyze different properties of multi-segmental intramedullary spinal cord tumors,including the location,the histological classification,the extent of tumor removal,and the prognosis in different age groups.Methods Between Jan.2002 and Dec.2009,78 patients with multi-segmental intramedullary spinal cord tumors were admitted to the neurosurgery inpatient department of Peking University Third Hospital.Patients younger than 18 year-old or 18 year-old were grouped into the adolescent group and patients older than 18-year-old were grouped into the adult group.Seventy-seven patients underwent microsurgery for the intramedullary spinal cord tumor using a posterior approach.The histological classifications and grades of tumors were determined by HE and Immunohistochemical staining.Preoperative and postoperative neurological function was scored using the Improved JOA（IJOA） scoring system.The prognosis was evaluated with IJOA difference values of patients.Data analysis was performed using SPSS 11.0（SPSS,Chicago,USA）.Results The difference in the histological classification of tumors（Z=-2.13,P=0.03）and IJOA difference values grading of patients（Z=-2.06,P=0.04） between the two groups was statistically significant.Benign glioma,mostly astrocytoma Ⅰ-Ⅱ,and neurodevelopmental tumor were predominant in the adolescent group and ependymoma where predominant in the adult group.The adolescent group had a better short-term prognosis than the adult group.Conclusions Multi-segmental intramedullary spinal cord benign glioma and neurodevelopmental tumor are predominant in the adolescent patients and has a relatively better short-term prognosis.On the contrary,ependymoma is predominant in the adult patients and has a relatively worse short-term prognosis.