成人恶性胶质瘤术中脑室开放和肿瘤接近脑室系统与肿瘤脑脊液播散的相关性研究  

Correlation study of both ventricular entry during operation and proximity of the tumor to the ventricular system and intracranial cerebrospinal fluid tumor dissemination in adult malignant gliomas

作　　者：韩武[1,2] 郝淑煜[1] 谢坚[1] 李志东[1] 于兰冰[1] 王江飞[1] 王磊[1] 高之宪[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科国家神经系统疾病临床医学研究中心,100050 [2]解放军海军总医院神经外科

出　　处：《中国微侵袭神经外科杂志》2016年第7期289-293,共5页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：北京市科委首都市民健康项目培育(编号:Z131100006813011)

摘　　要：目的探讨成人恶性胶质瘤术中脑室开放和（或）肿瘤接近脑室系统与肿瘤脑脊液播散的相关性,并分析肿瘤脑脊液播散病人的预后。方法回顾性分析1 20例幕上恶性胶质瘤病人的临床资料。其中31例病人发生脑脊液播散,89例未发生播散。绘制Kaplan-Meier生存曲线,进行Mantel-C ox检验评估术中脑室是否开放和肿瘤是否接近脑室两个因素单独及联合时对肿瘤脑脊液播散及生存率的影响。应用C ox比例风险回归模型来评估脑脊液播散对生存率的影响。通过Mann-W hitney U检验对比肿瘤脑脊液播散者与未播散者肿瘤残余程度的差异。结果术中脑室开放（P=0.6445）、肿瘤接近脑室系统（P=0.1 633）以及两者的变量组合（P=0.4044）对脑脊液播散无显著影响。术中脑室开放（P=0.9844）、肿瘤接近脑室系统（P=0.0528）以及两者的变量组合（P=0.5052）对术后生存率无显著影响。肿瘤发生脑脊液播散后生存率显著下降（风险比值为1.1 81,95%置信区间为1.068～1.31 4,P=0.0421）。播散组与未播散组间肿瘤残余体积差异无统计学意义（P〉0.05）。结论术中脑室开放和（或）肿瘤接近脑室系统对脑脊液播散的发生以及术后生存率均没有显著影响。然而,一旦发生脑脊液播散,生存率则显著下降。Objective To explore the correlation of ventricular entry during operation and/or proximity of the tumor to the ventricular system and intracranial cerebrospinal fluid（ CSF） tumor dissemination in adult patients with malignant gliomas, and analyze the prognosis of patients with CSF tumor dissemination. Methods Clinical data of 120 patients with supratentorial malignant gliomas were analyzed retrospectively, including 31 patients with CSF tumor dissemination and 89 without CSF tumor dissemination. The influences of the two factors as presence or absence of ventricular entry and the proximity of the tumor to the ventricular system alone or their combination on CSF tumor dissemination and survival rate were analyzed by using Kaplan-Meier survival curves and the Mantel-Cox test. A Cox proportional hazards model was used to assess the effect of CSF tumor dissemination on survival rate. Mann-Whitney U-test was used to compare difference in tumor residual volume between the patients with and without CSF tumor dissemination. Results The occurrence of CSF dissemination was not significantly influenced by ventricular entry during operation（P = 0.6445） or the proximity of the tumor to the ventricular system（P = 0.1633）, or combination of the two variables（P = 0.4044）. Survival rate after the operation was not evidently affected by ventricular entry during operation（P = 0.9844） or the proximity of the tumor to the ventricular system（P =0.0528）, or the two variables in combination（P = 0.5052）. The survival rate was evidently decreased once CSF tumor dissemination had occurred（RR=1.181, 95% CI： 1.068 to 1.314, P = 0.0421）. There was no significant difference in tumor residual volume between patients with and without CSF tumor dissemination（P 〉 0.05）. Conclusion Neither ventricular entry during operation nor the proximity of the tumor to the ventricular system separately or in combination significantly increases the occurrence of CSF tumor dissemination and survival rate after operation.

关 键 词：神经胶质瘤 脑脊液 肿瘤播散 脑室系统 生存率 

分 类 号：R739.41[医药卫生—肿瘤]