脑恶性胶质瘤术后放化疗复发再行手术治疗的临床分析  

Clinical Analysis of Reoperation Treatment for Brain Malignant Glioma Which Relapsed after Radiotherapy and Chemotherapy

作　　者：周晗 汪逵 邓民强 ZHOU Han;WANG Kui;DENG Minqiang(The Central Hospital of Enshi Autonomous Prefecture,Enshi,445000)

机构地区：[1]湖北省恩施土家族苗族自治州中心医院,445000

出　　处：《实用癌症杂志》2018年第11期1847-1849,1859,共4页The Practical Journal of Cancer

摘　　要：目的探讨脑恶性胶质瘤术后放化疗复发再行手术治疗的意义。方法选取原发脑恶性胶质瘤术后放化疗复发再行手术治疗患者32例,行黄荧光引导显微镜手术治疗。对比两次手术KPS分值、肿瘤体积、CD133/Nestin阳性表达;随访24个月左右记录生存率,对比不同切除方式、肿瘤体积、术前KPS分值、间隔手术时间患者生存期。结果与首次手术相比,再次手术肿瘤体积小,KPS评分高,CD133/Nestin阳性率高,P均<0. 05;两次手术时间间隔(9. 45±1. 50)个月;再手术行全切除术者共25例,行次全切除术者共7例;再手术6个月生存率为96. 88%,12个月生存率为81. 25%,24个月生存率为46. 88%。肿瘤体积≥50 cm、KPS <70分是生存期短的独立危险因素,P <0. 05。结论胶质瘤干细胞是复发主要因素,黄荧光引导显微手术能延长生存时间,而生存时间受术前KPS分值、肿瘤体积影响。Objective To analyze the significance of reoperation treatment for brain malignant glioma which relapsed after radiotherapy and chemotherapy.Methods Selected 32 cases treated with reoperation treatment of primary brain malignant glioma which relapsed after radiotherapy and chemotherapy,treated by yellow fluorescence-guided microsurgery.Compared the KPS score,tumor volume,CD133/Nestin positive expression of the 2 operations;recorded surgical results;Followed up for 24 months,survival rate was recorded,comparison of different ways resection,the tumor volume,preoperative KPS scores,the operation time interval of survival were conducted.Results Compared with the first operation,reoperation of tumor has the advantages of small volume,high KPS score,high positive rate of CD133/Nestin,P<0.05;the interval between the 2 operations were(9.45±1.50)months;reoperation for total resection were 25 cases,subtotal resection were 7 cases;6 months after reoperation,the survival rate was 96.88%,12 months after reoperation,survival rate was 81.25%and 24 months after reoperation,survival rate was 46.88%.The tumor volume of more than 50 cm?,KPS<70 were the independent risk factors for short survival time,P<0.05.Conclusion Glioma stem cell is the main factor of recrudescence.Yellow fluorescence-guided microsurgery can prolong the survival time,and the survival time is affected by preoperative KPS score and tumor volume.

关 键 词：脑恶性胶质瘤 复发 再手术 预后 黄荧光 

分 类 号：R730.264[医药卫生—肿瘤]