28例脑肿瘤患者放疗后再手术临床意义和适应证分析

Analysis on reoperation for suspected recurrent brain tumor following radiotherapy,and its indication

目的探讨放疗后脑肿瘤再手术的意义和适应证。方法 28例可疑脑肿瘤复发或放射性损伤而病情加重患者给予再次开颅手术,尽可能多地切除病灶及非功能区严重水肿脑组织以期颅内减压,部分患者同时减张修补硬脑膜后去骨瓣减压,回顾性分析这些病例的全部影像、病理及其临床资料。结果本组28例患者切除病灶同时去骨瓣者12例,术后恢复良好22例,出现并发症者包括:不完全性失语2例,偏瘫2例,因术后脑水肿而病情加重及切口感染长久不愈各1例。结论放疗后可疑复发或有明显占位效应而出现进行性临床症状加重时,应积极再手术治疗,不仅能明确肿瘤病理性质而且可有效地降低颅内压。

Objective To investigation the reoperation significance and indication for suspected recurrent brain tumor following radiotherapy.Methods The 28 cases of suspected recurrent brain tumor which had received operation and /or radiotherapy were given reoperation by resection tumor lesion and edema brain tissue of nonfunctionnal area as much as possible,some of them were given duramater relaxiation suture and bone flap decompression.Meanwhile retrospective analysis of their image,pathology and clinical data was taken.Results In the 28 cases received reoperationed,22 recoveried well,among whom 12 received tumor resection and bone flap decompression.The complications occured in 2 incomplete aphasia and 2 hemiplegia,1 severe brain edema and 1 scalp infection.Conclusion For the suspected recurrent brain tumor or exacerbation by mass effect following radiotherapy,the reoperation should be given early and actively which can not merely achieved the confirmed pathologic diagnosis but also decompression efficacy for intracranial site.