儿童视路胶质瘤患者术后视力的影响因素分析  

Analysis of the influencing factors of visual acuity post operation in children with optic pathway glioma

作　　者：张迪[1] 张天蕾 葛明[1] 杨伟 蔡英杰 张霓嘉 李楠[1] 齐翔[1] 邹哲伟[1] Zhang Di;Zhang Tianlei;Ge Ming;Yang Wei;Cai Yingjie;Zhang Nijia;Li Nan;Qi Xiang;Zou Zhewei(Department of Neurosurgery,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院神经外科,100045

出　　处：《中华神经外科杂志》2020年第6期574-578,共5页Chinese Journal of Neurosurgery

基　　金：首都临床特色应用研究项目(Z16110700050000)。

摘　　要：目的探讨儿童视路胶质瘤患者术后视力预后的影响因素。方法回顾性分析2015年1月至2018年8月首都医科大学附属北京儿童医院神经外科收治的30例视路胶质瘤患儿的临床资料。所有患儿均行肿瘤切除术,术后行放疗联合化疗1例,化疗25例。术后定期进行门诊和电话随访。采用单因素分析方法探讨可能影响患儿术后视力的因素。结果29例行肿瘤大部切除,1例行近全切除。术后病理学结果提示,毛细胞型星形细胞瘤9例,毛细胞黏液样星形细胞瘤21例。30例患儿中,1例失访,3例死亡,余26例患儿获随访3~48个月。至末次随访,与术前相比,17例患儿术后视力无损伤,9例术后视力受损,视力保留率为65.4%(17/26)。单因素分析结果表明,肿瘤最大径为儿童视路胶质瘤患者肿瘤切除术后视力的影响因素(P<0.001)。结论肿瘤最大径≥5 cm的视路胶质瘤患儿的术后视力损伤风险较高,有必要早期发现、早期干预。Objective To investigate the influencing factors of visual acuity after surgery of optic pathway glioma in children.Methods The clinical data of 30 children with optic pathway glioma admitted to Department of Neurosurgery,Beijing Children′s Hospital,Capital Medical University from January 2015 to August 2018 were retrospectively analyzed.All patients underwent tumor resection.Postoperative radiotherapy combined with chemotherapy was administered in 1 case and 25 cases underwent postoperative chemotherapy.Regular outpatient and telephone follow-up was conducted post discharge.The factors that might affect postoperative visual acuity of patients were statistically analyzed using univariate analysis.Results Gross total resection was achieved in 1 patient and subtotal resection in 29.Post operation,9 patients were pathologically diagnosed with pilocytic astrocytoma and 21 patients with pilomyxoid astrocytoma.Out of 30 patients,1 was lost to follow-up,3 died,and the remaining 26 were followed up for 3-48 months.Compared with preoperative conditions,17 children had stable visual acuity and 9 had impaired visual acuity post operation.The preservation rate of visual acuity was 65.4%(17/26).Univariate analysis showed that maximal tumor diameter was the influencing factor of visual acuity post operation of optic pathway glioma in children(P<0.001).Conclusions Children with the maximal tumor diameter≥5 cm seem to have a higher risk of visual impairment after surgery,and in those cases early detection and early intervention may be necessary.

关 键 词：神经胶质瘤 视通路 儿童 神经外科手术 视力预后 

分 类 号：R739.41[医药卫生—肿瘤]