脊髓髓内星形细胞瘤的临床特点及治疗策略分析  

Clinical Characteristics and Treatment Strategies of Spinal Intramedullary Astrocytoma

作　　者：李腾宇[1] 刘东康[2] 韩波[2] 韦玉军[3] 王贵怀[2,3] 

机构地区：[1]北京中医药大学附属东直门医院东区神经外科,北京101100 [2]首都医科大学附属北京天坛医院神经外科,北京100050 [3]首都医科大学附属北京神经外科研究所,北京100050

出　　处：《中国神经肿瘤杂志》2013年第4期248-252,共5页Chinese Journal of Neuro-Oncology

摘　　要：背景与目的：脊髓髓内星形细胞瘤一直是临床治疗的难点，本文旨在分析脊髓髓内星形细胞瘤的临床特点及治疗策略。方法：回顾性分析北京天坛医院2011年5月至2013年5月收治的31例手术治疗的脊髓髓内星形细胞瘤患者的临床资料，包括影像表现、病理类型、手术技巧、术后疗效等，采用McCormick分级和MRI影像学评估手术疗效。结果：肿瘤全切除3例，近全切除15例，部分切除11例，活检2例；术后近期临床神经功能改善1例，无变化23例，加重7例。术后随访3．24个月。20例I～Ⅱ级星形细胞瘤患者中，改善5例，无变化12例，恶化3例；11例高级别星形细胞瘤患者中，好转1例，加重4例，无变化者3例．死亡3例。结论：有明确边界的低级别星形细胞瘤首选显微手术治疗，尽可能全切除肿瘤：对边界不清的高度恶性胶质瘤可在激光刀等辅助技术下充分减压后行放化疗等相关治疗．但预后不良。分子靶向治疗可能是今后解决此问题的关键。BACKGROUND ＆ OBJECTIVE： The treatment for spinal intramedullary astrocytoma is difficult. In this article, we reviewed the clinical characteristics and treatment strategies of spinal intramedullary astrocytoma METHODS： Clinical data of 31 patients with intramedullary spinal cord astroeytoma were analyzed retrospectively, including pathological results, surgical techniques, prognosis, et al. All patients underwent microsurgical excision. The mierosurgieal effects were evaluated by McCormick scale and MRI. RESULTS： Total resection was achieved in 3 cases, subtotal in 15, partial in 11 and biopsy in 2, respectively. Function of spinal cord was improved in 1 case, unchanged in 23 and aggravated in 7 after the surgery, respectively. Duration of follow-up was 3 to 24 months, 20 cases of low grade, WHO I, II astroeytoma patients, improved in 5 cases, 12 cases without change, aggravated in 3 cases respectively. 11 cases of patients with high grade astrocytoma, improved in 1 case, aggravated in 4 cases, unchanged in 3 cases, 3 cases died. CONCLUSION： Microsurgical resection is the first choice for low grade astrocytoma with definite boundary. Decompression surgery with assistive technology such as the laser knife and chemoradiation are proposed for malignant astrocytoma with unclear boundary.

关 键 词：脊髓肿瘤 星形细胞瘤 手术治疗 

分 类 号：R739.41[医药卫生—肿瘤]