颅底脊索瘤临床分期及手术治疗

Clinical staging and surgical treatment of skull base chordomas

目的 通过对 61例颅底脊索瘤回顾性分析 ,简化原颅底脊索瘤分型并提出新的临床分期。方法 颅底脊索瘤 61例 ,典型脊索瘤 5 8例 ,软骨型脊索瘤 3例 ,男 34例 ,女 2 7例 ,男女之比为1 2 6∶1 ,年龄 7～ 75岁 ,平均 ( 38 44± 1 3 61 )岁。初诊患者 40例 ,复发患者 2 1例。术前或术后接受放射治疗 2 6例。分期方法 :鞍区型Ⅰ、Ⅱ、Ⅲ、Ⅳ期 ,斜坡型Ⅰ、Ⅱ、Ⅲ、Ⅳ期 ,广泛型只有Ⅳ期。随访时间 1 2～ 2 0 6个月。结果 61例患者本院接受 90例次手术 ,全切除 7例次 ,次全切除 2 6例次 ,大部分切除 41例次 ,部分切除 1 6例次 ;Ⅱ、Ⅲ、Ⅳ期手术分别为 2 1例、30例次、39例次 ;上方入路全切或次全切为 1 8例次 ( 37 5 % ) ,下方入路为 2 3例次 ( 5 4 8% )。并发症上方入路 2 1例 ( 4 3 75 % ) ,下方入路为 6例 ( 1 4 2 7% )。 3、5、1 0年生存率分别为 73 0 2 %、62 60 %、37 64%。结论 颅底脊索瘤临床分型与分期结合可以更好的对病变进行定位、定量、指导手术入路选择、比较疗效、评估预后。

Objective To suggest a new clinical staging system for skull base chordoma Methods Sixty one patients (58 typical chordomas and 3 chondroid chordomas)were evaluated and treated in Chinese PLA General Hospital between January, 1975 and December,2001 A total of 34 men and 27 women with a male/ female ratio of 1 26∶1 The patients ranged from 7 to 75 years, with a mean age of (38 44± 13.61). There were 40 Primary cases and 21 recurrent cases Pre and post operation radiotherapy was given to 26 patients Staging system are as follows:sellar type: stage Ⅰ,Ⅱ,Ⅲ and Ⅳ; clivus type: stageⅠ,Ⅱ,Ⅲ and Ⅳ; extensive type: staging Ⅳ Follow up was 12～206 months Results Sixty one patients received 90 operations, and total, near total, large part and partial resection was 7,26,41 and 16 respectively Stage Ⅱ,Ⅲ and Ⅳ operation was 21,30 and 39 time respectively;total and near total resection for superior approaches and inferior approaches were 18(37 5%)and 23(54 8%)times respectively 3,5 and 10 year survival rates were 72 80%,60 22% and 31 16% respectively Conclusions The combination of clinical staging and typing is beneficial for localizing and rationing the lesion It is a guide for operation and a standard to compare the results of different therapy