儿童中枢神经系统肿瘤219例临床分析

Clinical analysis of pediatric central nervous system tumors: a retrospective study of 219 cases

目的分析接受手术治疗的儿童中枢神经系统肿瘤的病理特点、治疗模式及治疗效果,为合理规范的治疗及改善患儿预后提供参考。方法对收治手术的219例中枢神经系统肿瘤患儿的临床资料进行回顾性分析。结果 219例儿童中枢神经系统肿瘤,以神经上皮组织来源肿瘤为主,其中主要是毛细胞型星形细胞瘤(25例)和WHOⅡ级星形细胞瘤(21例)。在成年人较多见的脑膜瘤比较少,而在儿童多见的髓母细胞瘤、生殖细胞肿瘤在本组中分别占8.2%(18例)和11.0%(24例)。在儿童高发的颅咽管瘤本组只占7.8%(17例)。主要临床表现为头痛、呕吐、肢体瘫痪、步态不稳、抽搐、视力下降。219例术后接受单纯放疗31例(14%),单纯化疗16例(7%),放疗+化疗39例(17.8%)。结论毛细胞星形细胞瘤、生殖细胞肿瘤、星形细胞瘤、髓母细胞瘤、颅咽管瘤是儿童常见的中枢神经系统肿瘤类型。手术为主要治疗手段,术后予以放化疗可改善恶性肿瘤患儿预后。

Objective To analyze the pathological diagnosis,treatment strategies and clinical results of central nervous system（ CNS） tumors in surgically treated children,and to provide data in setting treatment standard and improving prognosis. Methods Clinical materials were retrospectively analyzed for the surgically treated pediatric patients with CNS tumors. Results There were 219 cases that received surgical treatment. Among these tumors the most common type was of neuroepithelial origin,including pilocytic astrocytomas in 25 cases,astrocytomas（ WHO Grade Ⅱ） in 21 cases.The common tumor type in adults,meningioma was fewer in our series,while common tumor types in children found in our series were medulloblastomas（ 18 cases,8. 2%）,germ cell tumors（ 24 cases,11. 0%） and craniopharyngioma（ 17 cases,7. 8%）. The main clinical manifestations of craniopharyngioma were headache,vomiting,limb paralysis,gait instability,convulsion,and impaired vision. After surgery,31 cases（ 14%） received radiotherapy only,16 cases（ 7%） received chemotherapy only,while 39 cases（ 17. 8%） received radiochemotherapy. Conclusion Pilocytic astrocytoma,germ cell tumor,astrocytoma,medulloblastoma,craniopharyngioma are common types of CNS tumors in children. Surgery is the main treatment,radiotherapy and chemotherapy may improve prognosis for malignant tumor cases.