儿童视路胶质瘤手术前后体重变化的初步观察  

Preliminary observation of the weight change of children with optic glioma before and after surgery

作　　者：赵凤毛[1] 葛明[1] 孙骇浪[1] 张天蕾 Zhao Fengmao;Ge Ming;Sun Hailang;Zhang Tianlei(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》2021年第12期1267-1270,共4页Chinese Journal of Neurosurgery

摘　　要：目的初步探讨视路胶质瘤(OPG)患儿手术前后体重的变化。方法回顾性分析2015年7月至2020年12月首都医科大学附属北京儿童医院神经外科收治的36例视路胶质瘤患儿的临床资料。所有患儿均接受肿瘤切除术,基于术中观察及术后复查头颅MRI增强扫描的结果评估肿瘤的切除程度,其中将肿瘤切除体积为60%~90%定义为大部切除,>90%定义为近全切除。分别于术后1、2周,1、3、6以及9个月对患儿进行门诊复查或网上随访。随访内容包括:患儿的后续治疗情况、肿瘤有无复发、播散转移及体重变化等。根据患儿的性别、出生日期、体重及其测量日期等计算年龄别体重Z评分(WAZ),进一步计算两次随访间患儿WAZ增长速度,即(第n+1次随访时WAZ-第n次随访时WAZ)×1000/随访间隔时间(d)。采用单样本t检验分别比较患儿手术前、后WAZ与国际儿童标准WAZ。采用重复测量方差分析比较患儿术后不同时间点的WAZ以及WAZ的增长速度。结果36例患儿均顺利完成手术,其中28例肿瘤大部切除,8例肿瘤近全切除。病理学结果显示毛细胞型星形细胞瘤11例,毛细胞黏液样星形细胞瘤25例。36例患儿术后中位随访时间(范围)为25个月(9~40个月)。至末次随访,36例患儿均无肿瘤复发及转移,16例术前存在视觉症状的患儿视觉症状均有所好转。36例OPG患儿的术前WAZ为(-0.76±2.32)分,低于国际正常儿童WAZ的总体均值[(0±1.00)分],差异有统计学意义(P=0.024);术后9个月WAZ为(0.82±2.14)分,高于国际正常儿童WAZ的总体均值[(0±1.00)分],差异有统计学意义(P=0.006)。患儿术后WAZ较术前增加,术后1个月时WAZ最高且增长速度最快(均P<0.05)。结论初步观察发现,OPG患儿肿瘤切除术后体重较前增加,且在术后早期增长速度最快。Objective To preliminarily explore the weight change of children with optic glioma(OPG)before and after surgery.Methods A retrospective analysis was conducted on the clinical data of 36 children with OPG admitted to the Department of Neurosurgery,Beijing Children′s Hospital,Capital Medical University from July 2015 to December 2020.All children underwent tumor resection.The degree of tumor resection was evaluated based on the results of intraoperative observation and postoperative re-examination of enhanced MRI of the head.The tumor resection volume of 60%-90%was defined as a major resection,and the tumor resection volume of>90%was defined as subtotal resection.The children were reviewed in outpatient clinics or online follow-up at 1,2 weeks,1,3,6 and 9 months after surgery.Follow-up content included subsequent treatment of the child,whether the tumor had recurred,spread and metastasis,and weight change.The weight-for-age Z-score(WAZ)was calculated based on the child′s gender,date of birth,weight and date of measurement,and the rate of increase in the child′s WAZ between two follow-ups was further calculated,which was(WAZ at the n+1 follow-up-WAZ at the n follow-up)×1000/interval between follow-ups(d).The single-sample t test was used to compare the WAZ before and after the operation with the international standard WAZ for children.Repeated measures analysis of variance was used to compare the WAZ and WAZ growth rate at different time points after the operation.Results All 36 cases of children successfully underwent the operation,of which 28 cases of tumors were largely removed,and 8 cases of tumors were subtotally removed.Pathological results showed 11 cases of pilocytic astrocytoma and 25 cases of pilocytic myxoid astrocytoma.The median follow-up time(range)of 36 children was 25 months(9-40 months).At the last follow-up,there was no tumor recurrence or metastasis in 36 children,and the visual symptoms of 16 children improved.The preoperative WAZ of 36 children with OPG was-0.76±2.32 points,which was low

关 键 词：神经胶质瘤 儿童 体重 显微外科手术 

分 类 号：R739.7[医药卫生—肿瘤]