6例胶质瘤术后放射性脑病误诊为胶质瘤复发的临床分析

Six Cases of Postoperative Radiation Encephalopathy Misdiagnosed as Recurrent Glioma

目的探讨胶质瘤术后放射性脑病与胶质瘤复发的鉴别。方法回顾分析我院2005年4月～2010年8月6例胶质瘤术后经放射治疗误诊为胶质瘤复发的临床资料。结果 5例病变全切,1例大部切除(切除90%)。6例病理结果为放射性脑病。1例术后右侧肢体肌力较术前转差(术前Ⅳ级,术后Ⅰ～Ⅱ级)。术后9～14 d出院。6例随访6～24个月,平均9.5月,患者恢复良好1,例术后8个月因胶质瘤复发再次入院。结论胶质瘤术后放射性脑病与胶质瘤复发难以区别,临床上容易误诊,应综合患者病史、复发时间、临床症状、影像学表现等多因素特征,提高临床鉴别诊断水平,降低误诊率的发生。

Objective To investigate the differentiation diagnosis between recurrent glioma and postoperative radiation encephalopathy. Methods We reviewed retrospectively the clinical data of 6 cases of glioma which were misdiagnosed as recurrent tumor after surgical treatment and radiotherapy in our hospital between April 2005 and August 2010. Results In the 6 cases, total excision was performed on 5 cases, and partial removal （90%） in the other one. Pathological examination showed radiation encephalopathy in all the 6 cases. One of the patients showed lower strength of the left limb （decreased from grade 1V preoperation to grade Ⅰ- Ⅱ postoperation）. The patients were discharged from the hospital in 9 to 14 days, and 6 of them were followed up for a mean of 9.5 months （6 - 24 months）. All the patients recovered well, except for one, who was admitted to hospital again in 8 months because of recurrent glioma. Conclusions It is difficult to differentiate radiation enccphalopathy from recurrent glioma. Medical history, recurrent time, symptoms, imaging results may contribute to diagnosis.