下丘脑胶质瘤的临床诊疗分析

The clinical features and surgical treatment strategy of hypothalamic gliomas

目的 探讨下丘脑胶质瘤（HG）的临床表现和影像学特点,评估手术疗效和预后.方法 回顾分析南方医院神经外科收治的36例HG患者的临床资料,并行长期随访.结果 囊实性HG多见于毛细胞型星形细胞瘤;钙化多见于星形或少突星形细胞瘤.术后早期内分泌均有不同程度下降,多轴激素缺乏和尿崩发生率,在全切除组和次全切除＋部分切除组间差异无统计学意义（P =0.409和0.324）.随访期7例肿瘤复发,全切除组3例均为高级别肿瘤,低于次全切除＋部分切除组（P =0.022）.两组生活质量差异无统计学意义（P =0.421）.结论 明确HG临床和影像学特点,有助于术前诊断.手术仍为首选,全切除能降低肿瘤复发率,且未加重术后尿崩和内分泌水平改变.对下丘脑界面不清的病例,以充分减压为基础的次全切除,在减少围术期病死率的同时,能获得较好的临床效果.

Objective To investigate the clinical manifestation and radiological features of hypothalamic glioma （HG）,and to evaluate the surgical efficacy and prognosis.Methods 36 cases of HG presenting in the department of neurosurgery of Nanfang hospital were respectively analyzed.The long term follow-up was performed through recheck in outpatient department,telephone and letter.Results Solid and cystic mixed tumor was more common in pilocytic astrocytoma （PAS）.However,fiber astrocytoma was predominantly solid.The calcification of tumor was more common in astrocytoma or oligodendroglioma.The postoperative endocrinological deterioration in varying degrees was found in all patients.Between GTR group and STR ＋ PTR group,there was no significant difference of the incidence of multi-axial hormone deficiency （P =0.474） and diabetes insipidus after surgery （P =0.366）.During the follow-up period,among 7 recurrence cases,three occurred in GTR group （18.7％）,was slightly lower than STR ＋ PTR group （P =0.022）.Moreover,there was no difference about the quality of life of two groups （P =0.216）.Conclusions It was useful to make the clinical diagnosis better with well understanding the clinical characteristics of HG.Surgical treatment remained the first choice of treatment.GTR won＇t deteriorate the incidence of diabetes insipidus and endocrine levels more than STR ＋ PTR.For unclear interface and close adherence to hypothalamus,STR based on sufficient decompression reduced the perioperative incidence of death,and meanwhile obtained the satisfying clinical effects.