额颞枕叶非功能区胶质瘤的手术策略  

Surgical Strategies of frontal, temporal, and occipital lobe gliomas in non-functional areas

作　　者：季晶[1] 张军霞[1] 颜伟[1] 曹胜武[1] 王颖毅[1] 王彬彬[1] 赵春生[1] 赵鹏[1] 刘宁[1] 尤永平[1] 

机构地区：[1]南京医科大学第一附属医院神经外科,210029

出　　处：《中华神经外科杂志》2016年第5期467-472,共6页Chinese Journal of Neurosurgery

基　　金：国家高技术研究发展计划（863计划）（2012AA02A508）;国家自然科学基金（81272792,81472362,81300998）;江苏省临床医学科技专项（BL2012028）;江苏省“兴卫工程”医学重点学科（XK201117）

摘　　要：目的探讨额、颞、枕叶非功能区胶质瘤的临床特征及手术治疗策略。方法回顾性分析南京医科大学第一附属医院2009年1月至2013年1月治疗的病变位于额、颞、枕叶非功能区，病例资料完整的胶质瘤患者的临床资料，共89例。术前根据影像学显示肿瘤的部位、大小及水肿程度进行分型并制定相应的手术策略，最大程度切除肿瘤组织。术中常规应用导航和B超定位，使用黄荧光显微镜辅助切除。结果89例患者中，病变局限于皮质者49例，局限于脑室深部者11例，同时侵犯脑室和皮质者29例；病变局限于1个脑叶者67例，侵犯多个脑叶者22例。术后病理学证实肿瘤为WHOⅠ级者12例，Ⅱ级者21例，Ⅲ级者29例，Ⅳ级者27例。术后MRI证实肿瘤全切除74例（83．1％），次全切除11例（12．4％），大部切除2例（2．2％），部分切除2例（2．2％）。术后平均随访（30．0＋3．6）个月，Kaplan—Meier生存曲线分析显示，WHOm级者2年的生存率为51．7％，Ⅳ级者为33．3％。随访期间共死亡41例（46．1％），其中WHOⅣ级者21例（77．8％），中位生存期为19．4（11．5～30．2）个月；WHOⅢ级者18例（62．1％），中位生存期为26．7（19．1—36．5）个月；WHOⅡ级者2例（9．5％）；WHOI级者无死亡。结论影像学指导下额、颞、枕叶非功能区胶质瘤的手术方法和切除范围有助于提高患者的肿瘤全切率和生存时间。Objective To summarize the clinical characteristics and surgical treatment strategies of frontal, temporal, and occipital lobe gliomas in non-functional areas. Methods From January 2009 to January 2013, the clinical data of 89 patients with glioma who had complete data and whose lesions located in frontal, temporal, and occipital lobe non-functional areas treated in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. The Corresponding surgical strategies were selected according to preoperative imaging showed the location and size of the tumors and edema degree. The tumor tissues were maximally removed. Routine use of navigation and B-ultrasound localization during the operation, the gliomas were removed by using the yellow fluorescence microscope-assisted resection. Results In 89 patients, the lesions of 49 patients were confined to the cortices, 11 were confined to the deep brain ventricles, and 29 invaded the ventricles and cortices at the same time. The lesions of 67 patients were confined to one lobe and 22 invaded a plurality of lobes. The postoperative pathology confirmed that the tumors of 12 patients were WHO grade Ⅰ, 21 were WHO grade Ⅱ, 29 were WHO grade Ⅲ, and 27 were WHO grade IV. The postoperative MRI confirmed that 74 patients （83. 1% ） had total resection, 11 （12. 4% ） had subtotal resection, and 2 （2.2%） had near-total resection, and 2 （2.2%） had partial resection. The mean follow-up time after procedure was 30.0 ＋ 3.6 months. The 2-year survival rate of WHO grade Ⅲ was 51.7% and that of WHO grade Ⅳ was 33.3%. Forty-one patients died during the follow-up period, including 21 （77.8%） with WHO grade Ⅳ, and their median survival time was 19.4 （ 11.5 - 30.2） months ; 18 （62.1% ） with WHO grade Ⅲ, and their median survival time was 26.7 （ 19.7 - 36.5 ） months ; 2 （9.5%） with WHO grade Ⅱ, and none of them with WHO grade Ⅰ died. Conclusion Under the guidance of the imaging, the surgical methods and resection ra

关 键 词：神经胶质瘤 额叶 颞叶 枕叶 神经外科手术 非功能区 

分 类 号：R739.41[医药卫生—肿瘤]