非典型脑膜瘤的诊治与预后分析  

Analysis of Diagnosis,Treatment and Prognosis of Atypical Meningioma

作　　者：宋志富 吴文友[1] 夏祥国 郑悍东 甘玉兰 庞国银 谭灵[1] 

机构地区：[1]泸州市人民医院神经外科,四川泸州646000 [2]西南医科大学附属医院,四川泸州646000

出　　处：《四川医学》2017年第5期534-537,共4页Sichuan Medical Journal

摘　　要：目的探讨非典型脑膜瘤(AM)的诊治特点并分析影响其预后的因素。方法回顾性分析28例AM患者的临床资料,根据随访结果将患者分为未复发组(20例)和复发死亡组(4例复发存活、4例复发死亡),对两组患者临床资料的19项指标进行统计学分析。结果 28例AM患者共行39次手术,其中1次手术20例,2次手术3例,3次手术3例,4次手术1例;肿瘤均SimpsonⅠ级切除;术后均未放疗,随访6个月~5年,8例患者复发(28.57%),平均复发时间2.19年(0.5年~5年);不同预后的患者性别、年龄、瘤卒中、大小、有无分叶、钙化、脑膜尾征、质地、是否分切及血供差异无统计学意义(P>0.05),肿瘤部位、瘤周水肿、坏死、粘连、瘤脑边界、侵袭性、包膜、术中失血、Ki-67差异有统计学意义(P<0.05)。结论 AM临床表现无特异性,首选显微手术切除,当肿瘤位于非大脑凸面,周围水肿严重,有坏死粘连、肿瘤无包膜、边界不清,对周围组织有侵袭,术中失血≥375m L,Ki-67≥8%时易复发,术后应结合放疗,并密切随访。Objective To investigate the features of diagnosis and treatment of atypical meningioma（AM） andanalyze the factors affecting its prognosis. Methods The clinical data of 28 patients with AM were retrospectively analyzed. The patients were divided into no recurrence group（ n = 20）and recurrence death group（4 cases relapsed and survived, and 4 cases died of recur- rence） according to the results of follow-up. The 19 indicators of clinical data of patients in the two groups were statistically ana- lyzed. Results 28 cases of AM patients underwent a total of 39 operations ,including 20 cases of 1 operation,3 cases of 2 opera- tions,3 cases of 3 operations,and /case of 4 Operations. All tumors were treated with Simpson grade I resection. No postoperative radiotherapy was performed. All patients were followed up for 6 months to 5 years. 8 patients relapsed（ 28.57% ） , and the average recurrence time was 2. 19 years（0. 5 to 5 years）. There was no significant difference in prognosis with gender, age, tumor stroke, size, leaves or not, calcification, dural tail sign, texture, whether to cut and blood supply （ P 〉 0. 05 ）. The prognosis was statistically significantwith tumor site, peritumoral edema, necrosis, adhesion, tumor border, invasiveness, capsule, intraoperative blood loss, and the difference of Ki-67 （ P 〈 0.05 ）. Conclusion The clinical manifestations of AM are not specific,and the first choice is micro- surgical resection. When located in the non-convexity of brain, severe edema of the surroundings, necrosis and adhesion, no tumor capsule, noclear boundary, invasion of the surrounding tissue, intraoperative blood loss more than 375 ml, and Ki-67 〉I 8 % , the tumor is easy to relapse ,which should be combined with postoperative radiotheraov and close follow-uo.

关 键 词：非典型脑膜瘤 非典型脑膜病 诊断 治疗 预后 

分 类 号：R739.45[医药卫生—肿瘤]