显微外科手术治疗儿童延髓胶质瘤及预后分析（附18例报告）  

Microsurgical treatment of pediatric medullary gliomas and its prognostics： a report of 18 cases

作　　者：张义松[1] 泮长存[1] 戴缤[1] 张鹏[1] 汤劼[1] 吴震[1] 张俊廷[1] 张力伟[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华神经外科杂志》2017年第5期456-460,共5页Chinese Journal of Neurosurgery

基　　金：国家“十二五”科技支撑计划（2014BA104B01,2015BA112B04）;北京市自然科学基金（7161004）;北京市医院管理局重点医学专业发展计划（ZYLX201608）

摘　　要：目的探讨显微外科手术治疗儿童延髓胶质瘤的临床特征及预后的影响因素。方法回顾性纳入首都医科大学附属北京天坛医院神经外科2008年1月至2013年10月收治的18例延髓胶质瘤患儿的临床资料，所有患儿均行显微外科手术治疗，术后定期随访，随访内容包括患儿的临床症状、肿瘤是否复发、生存时间及死亡原因。对影响患儿术后生存时间的临床因素进行预后分析。结果18例患儿的肿瘤全切除4例，次全切除9例，部分切除5例。病理诊断均为胶质瘤，其中WHOI级1例（毛细胞型星形细胞瘤），WHOⅡ级14例（星形细胞瘤12例和少突胶质细胞瘤2例），WHOⅢ级2例（问变性星形细胞瘤），WHO1V级1例（胶质母细胞瘤）。术后1个月患儿临床症状改善15例，加重3例。随访时间为4～103个月，平均随访时间为（38．2±29．9）个月。术后复发死亡6例，患儿1年生存率为76％，5年生存率为63％，生存时间均值为（70．4±10．7）个月。肿瘤病理WHO分级[RR（95．0％CI）=127．613（2．365～6885．170），P〈0．001]和切除程度[RR（95．0％CI）=12．408（1．361～113．150），P=0．008]是影响患儿生存时间的主要临床因素，也是影响患儿预后的独立危险因素。结论儿童延髓胶质瘤低级别偏多，肿瘤的病理分级和切除程度可作为判断预后的重要因素。Objective To explore the clinical features and prognosis factors of microsurgery treatment of pediatric medullary gliomas. Methods Clinical data of 18 patients with pediatric medullary gliomas who underwent microsurgical treatment at the Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University from January 2008 to October 2013 were retrospectively analyzed in this study. Regular postoperative follow-up was conducted and the following informations including the patients＇ symptomatic outcome, tumor recurrence, survival time and cause of death were documented. Prognosis factor analysis of the patient＇s postoperative survial time was conducted. Results Among the 18 patients, gross total resection was achieved in 4 cases, subtotal resection in 9 cases and partial resection in 5 cases. Postoperative pathological findings confirmed the diagnosis of glioma in all cases, which, according to the World Health Organization （WHO） criteria, included a case of grade Ⅰ （ pilocytic astrocytoma） , 14 cases of grade Ⅱ（ 12 astrocytomas and 2 oligodendrogliomas）, 2 cases of grade Ⅲ（ anaplastic astrocytomas） and 1 case of grade IV （glioblastoma）. The follow-up period was 4 - 103 months, with a median of （38.2±29.9） months. Six cases died of tumor recurrence. The 1-year and 5-year survival rates were 75.6% and 63.0%, respectively. The mean survival time was （ 70. 4±10. 7 ） months. The pathological grade [ RR（95.0% CI） = 127. 613（2. 365 -6885. 170） ,P 〈 0. 001 ] and extent of resection [RR （95.0% CI） = 12. 408（ 1. 361 -113. 150）,P = 0. 008] were determined to be independent factors affecting the patients＇ outcomes. Conclusion Pediatric medullary gliomas seemed mostly low grade, and the pathological grade and extent of resection might serve as important prognostic factors.

关 键 词：延髓 神经胶质瘤 儿童 显微外科手术 预后 

分 类 号：R739.4[医药卫生—肿瘤]