儿童髓母细胞瘤的显微手术治疗

Microsurgery of medulloblastomas in chil dren

目的 总结 61例显微手术切除儿童髓母细胞瘤的经验 ,探讨儿童髓母细胞瘤手术治疗策略。方法 自 1 995～ 2 0 0 2年同济医院对 61例儿童髓母细胞瘤进行了显微手术治疗 ,其中男46例 ,女 1 5例 ,年龄 1～ 1 0岁 ,平均 6 .3岁。病程 3～ 2 5周 ,平均 6周。病变位于小脑半球 1例 ,60例肿瘤均位于小脑蚓部。肿瘤 1～ 3cm者 7例 ,3～ 5cm者 2 5例 ,大于 5cm以上者 2 7例。所有病例手术后通过影像学 (CT和MRI检查 )和生存质量的观察 ,随访 1～ 7年 (随访 5年以上 4例 ,2～ 4年 46例 ,2年以内 1 1例 )。半年、1年、3～ 5年分别复查CT或MRI ,6例患儿因经济原因仅在手术后半年时 ,复查 1次。结果 全组病例中 ,肿瘤全切 55例 ,大部切除 6例 ,手术死亡 3例 ,病死率为 4 .9% (3/61 ) ,未出现严重并发症。患儿生存质量得到提高。结论 掌握显微手术方法和手术中注意事项 ,有利于提高肿瘤切除程度及减少手术并发症 ,手术后必须辅助放疗 ,通过采取这些措施 。

Objective To sum up the experiences in microsurgical technique of medulloblastomas. Methods From June 1995 to June 2002, 61 children with medulloblastomas underwent microsurgical operation. There were 46 boys and 15 gi rls. Their age ranged from 1 to 10 years with an average of 6.3 years. They were symptomatic for 3～25 weeks (average 6 weeks). The lesion was located in cerebellar hemisphere in 1 patient, the remaining ( n =60) was located in cerebellar vermis. The size was 1～3?cm in diameter in 7 cases, 3～5?cm in 25 and over 5?cm in 29. All patients were followed-up from 1～7 years postoperatively by imaging studies. Results Among them, the tumor was removed completely i n 55, subtotal removal in 6 and 3 died ( 4.92% ).There was no serious postope rative complication. Conclusions Microsurgical technique is conducive to more c omplete tumor removal. It also reduces the postoperative complication. The autho rs suggest that postoperative radiotherapy should be applied. The prognosis of medulloblastoma may be improved with these measures.