颅内肿瘤立体定向放射治疗后再手术影响因素分析——附28例报告  

Influence factors of the intracranial tumors need operation after stereotactic radiotherapy treatment(28 cases report)

作　　者：王文涛[1] 殷利明[1] 钟德泉[1] 赵展[1] 徐伟光[1] 

机构地区：[1]广东药学院附属第一医院神经外科,510080

出　　处：《辽宁医学杂志》2014年第5期249-251,共3页Medical Journal of Liaoning

摘　　要：目的探讨颅内肿瘤立体定向放射外科（SRS）治疗后再手术的原因及影响手术效果的因素。方法回顾性分析28例行SRS治疗后再手术颅内肿瘤患者的术前MR、手术操作特点、病理结果,总结颅内肿瘤SRS患者再手术的原因及影响因素。结果本组患者均行SRS治疗,其中γ-刀治疗18例,X-刀治疗10例。随访2~30个月,病情加重或反复,术前MR检查见肿瘤或病灶增大25例,内部坏死19例,囊性变3例,周围水肿或脱髓鞘改变25例,病灶周围新生强化结节14例,脑积水2例,共接受手术28次,肿瘤或病灶切除23例,去骨瓣减压18例,囊肿穿刺3例,分流手术2例。术后病理见肿瘤坏死19例,肿瘤残留复发22例,胶质增生13例,周围脑组织坏死19例。结论 SRS治疗后再手术前MR检查形态多样,区别病灶复发、坏死与胶质增生困难,周围水肿重,多需去骨瓣减压,术中难以辨别肿瘤及胶质增生病灶,周围水肿脑组织保护困难。主张严格掌握SRS适应证,应采取以手术治疗为主的综合治疗。Objective To investigate the cause of intracranial tumor need operation after stereotactic radiosurgery （SRS） treatment and the influence factors of operation effect. Methods Retrospective analysis of MR before operation,operation characteristics, pathological findings in 28 cases of intracranial tumors need operation after stercotactic radiotherapy treatment. Summarize the reasons and influencing factors of the patients with SRS need operation. Results All the patients were treated with SRS, 18 patients were treated with gamma knife, X- knife treatment in 10 cases. During the follow-up of 2 - 30 months, illness or repeatedly,the preoperative MR examination showed the tumor or lesion increased in 23 cases, 19 cases of internal necrosis,3 cases of cystic degeneration, edema and demyelination changes in 25 cases, new enhanced nod- ules around lesions in 14 cases, hydrocephalus in 2 cases. A total of 28 times to accept operation, tumor or lesion resection in 23 cases, bone flap decompression in 18 cases,3 cases of cyst puncture, shunt operation in 2 cases. Pathological findings after surgery,21 cases of tumor necrosis , residual tumor recurrence in 22 cases, glial hyperplasia in 13 cases, 19 cases of surrounding brain tissue necrosis. Conclusion There are various forms in MR of the patiens before operatio with SRS ther- apy. It＇ s difficult to difference the recurrence, necrosis and glial hyperplasia. If the cerebral edema was severe, decompres- sive craniectomy were needed. It＇ s difficult to distinguish tumor and colloid hyperplasia lesions and protect the peripheral edema brain tissue in operation. Advocate strict control of indications for SRS, should adopt the combined therapy mainly with operation.

关 键 词：颅内肿瘤 立体定向放射外科 手术 

分 类 号：R739.41[医药卫生—肿瘤]