30例外侧裂区胶质瘤的显微手术分析

Microsurgery for 30 cases with gliomas in sylvian fissure area

目的探讨影响外侧裂区胶质瘤显微手术的相关因素。方法对30例经手术证实为外侧裂区胶质瘤患者的临床及随访资料进行回顾性总结,分析术前MRI检查结果、术后情况,统计获访患者的生存时间。并根据术前是否行颅脑CT血管显像(CTA)检查对获访的间变星形细胞瘤患者进行分组:CTA组和对照组,比较两组的生存时间。结果 30例外侧裂胶质瘤患者临床资料中,肿瘤全切除24例,次全切除3例,大部切除3例;术后KPS≥70分25例,<70分5例;术后病理显示间变星形细胞瘤14例,少突胶质瘤8例,胶质母细胞瘤8例。14例间变星形细胞瘤患者中,6例术前行颅内血管CTA检查,并根据肿瘤与周围血管关系,分为包裹型1例,挤推型4例,混合型1例,CTA组的生存时间明显优于对照组(P<0.05),中位生存时间分别为54个月与20个月。结论经外侧裂入路,术前充分影像学评估及术中精细操作,能显著提高侧裂区胶质瘤全切率;对于间变星形细胞瘤患者术前行CTA检查,可提高肿瘤切除率,提高生存质量,延长患者术后生存时间。

Objective To discuss microsurgical treatment for gliomas located in sylvian fissure. Methods Data of 30 glioma cases, who were treated by operation and radiotherapy, were retrospectively analyzed, including preoperative MRI and survival. The patients were divided into two groups：CTA group and control group. Results By microsurgery, 24 cases were total resected, 3 cases with subtotal resection, and 3 cases with greater partial resection. As postoperative KPS, 25 cases were more than 70 points and the others were lower than 70 points. Postoperative pathology showed 14 cases had anaplastic astrocytoma, 8 cases had oligodendroglioma and 8 cases had glioblastoma. 6 patients with anaplastic astrocytoma, who received vascular CTA examination preoperatively, were divided into package type in 1 case, squeezing type in 4 cases and mixed type in 1 case according to the relationship between tumor and surrounding blood vessels. In addition, survival time of CTA group was longer than the control group. Conclusions （ 1 ） Through lateral fissure approach, preoperative imaging evaluation and careful operation will improve significantly operating rate of gliomas in the lateral fissure area; （2） For the patients with anaplastic astrocytoma, preoperative CTA examination could improve tumor resection rate and survival quality, and extend the patients＇ postoperative survival time.