小儿髓母细胞瘤的显微手术治疗策略

Microsurgical strategies of medulloblastoma in children

目的探讨小儿髓母细胞瘤的显微手术技巧、治疗策略及经验教训。方法收集2006年1月～2010年4月资料较完整经手术证实的儿童髓母细胞瘤26例,对其临床资料进行回顾性分析。结果全切除5例,次全切除19例,部分切除2例,全部病例术后脑脊液循环通路打通;继发呼吸循环衰竭死亡2例;术后幕上、下硬膜下积液,经皮置管并加压包扎后好转;26例24例病情好转稳定后出院;1例小脑表面播散转移;6例术后进行全脑全脊髓放疗;1例术后行原发部位的伽玛刀治疗,后出现椎管内播散;1例出现小脑缄默症;5例全切者在术后6个月至2年发现肿瘤复发3例,未能治疗而死亡,17例次全切除患者术后获随访10例死亡6例,存活至今4例。结论应用显微手术技术,尽可能切除肿瘤,手术后辅助放、化疗,有利于减少手术并发症并改善预后。

Objects To explore the microsurgical techniques,curative strategies and experinces of medulloblastoma in children. Methods The clinical data of 26 children with medulloblastoma who underwent microsurgery from January ,2006 to April,2010 were analyzed retrospectively. Results Of 26 patients, 5 underwent total resection of tumors, 19 subtotal and 2 greatly partial. All cases of postoperative CSF circulation pathway opened up, 2 patients died of secondary respiratory and circulatory failure. After screen, the next hard under the fluid membrane, pereutaneous catheter and bandaged after the turn for the better. Of 26 patients,24 discharged after stable condition improved, one case of cerebellar surface disseminated metastasis,6 cases for the whole spinal cord whole brain radiotherapy, one case of postoperative the primary site of the gamma knife treatment of disseminated within the spinal canal, one case of eerebellar tourism,5 cases of total removal in the 6 months to 2 years, 3 patients died of treatment failure, 17 cases of subtotal resection patients were followed up 10 patients died in 6 cases, 4 patients have survived. Conclusion Microsurgical technique, intraoperative attention to grasp the main points as much as possible to remove the tumor, postoperative adjuvant radiotherapy or chemotherapy can help to reduce complications and improve prognosis.