46例头颈部神经纤维瘤的临床分析  

Head and neck neurofibromas： analysis of 46 cases

作　　者：刁向宇 刘文胜[1] 张彬[1] 鄢丹桂[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院头颈外科,100021

出　　处：《中华肿瘤杂志》2015年第7期526-529,共4页Chinese Journal of Oncology

摘　　要：目的分析头颈部神经纤维瘤的手术方式、复发及预后情况，探讨其治疗策略。方法回顾性分析46例神经纤维瘤的临床资料，其中41例患者获得有效随访。分析头颈部神经纤维瘤患者的临床病理特征、手术方式、治愈情况和神经功能。结果41例获得有效随访的患者中，治愈26例，未治愈15例（其中死亡2例）。伴有和不伴有Ⅰ型神经纤维瘤病的神经纤维瘤患者的治愈率分别为42．9％和85．0％，差异有统计学意义（P=0．005）。局限型、侵袭型、弥漫型和串珠型患者的治愈率分别为100．0％、46．6％、40．0％和66．7％，差异有统计学意义（P=0．009）。肿瘤彻底切除（包括扩大切除和完整切除）和部分切除患者的治愈率分别为73．5％和14．3％，差异有统计学意义（P=0．011）。扩大切除与部分切除患者的治愈率分别为80．0％和14．3％，差异有统计学意义（P=0．029）。完整切除患者的治愈率为70．8％，与部分切除患者比较，差异有统计学意义（P=0．026）。但完整切除与扩大切除患者的治愈率差异无统计学意义（P=0．581）。Cox多因素回归分析显示，肿瘤切除彻底与否是影响神经纤维瘤患者预后的独立因素。结论神经纤维瘤是具有侵袭特征的良性肿瘤，部分肿瘤复发率高、治愈率低，且术后神经损伤常难以避免，术后神经功能与预后受多种因素影响，因此需慎重选择手术时机及手术方式。Objective To investigate the surgical mode, recurrence and prognosis for patients with head and neck neurofibromas and explore their treatment strategies. Methods The clinicopathological features, operation mode, prognosis and neural function of 46 patients with head and neck neurofibroma were analyzed retrospectively, and 41 of the cases were followed up for 24-170 months （median 74 months）. Results Among the 41 followed-up patients, 26 patients were cured and 15 patients were not cured （ two died）. The cure rate of the neurofibromas with neurofibromatosis type 1 （NF1） and the neurofibromas without NF1 were 42.9% and 85.0%, respectively （P=0.005）. The cure rate of localized, aggressive, diffuse and beaded neurofibromas were 100.0%, 46.6%, 40.0% and 66.7%, respectively （P= 0.009）. The cure rate of radical resection （including expanding excision and complete resection） and partial resection were 73.5% and 14.3%, respectively （P= 0.011 ）. The cure rates of expanding excision and partial resection were 80.0% and 14.3% （P= 0.029）. The cure rates of complete resection and partial resection were 70.8% and 14.3%, respectively （P=0.026）. However, the cure rates of expanding excision and complete resection were not significantly different （P= 0.581 ）. Multivariate Cox model analysis indicated that thoroughness of surgery was the independent risk factor for the prognosis for patients with head and neck neurofibromas. Conclusions Neurofibroma is a kind of aggressive benign tumors. Some neurofibromas have a high recurrence rate and low recovery rate, and some nerves are essay to be injured in the operation. Lots of factors impact on the prognosis and recovery of the neural function. Therefore, operation opportunity and mode should be carefully selected.

关 键 词：神经纤维瘤 神经纤维瘤病 治疗结果 预后 

分 类 号：R739.91[医药卫生—肿瘤]