成年人下丘脑胶质瘤手术疗效分析  

The surgical outcome of adult patients with hypothalamic gliomas

作　　者：任晓辉[1] 李浩诣 崔勇[1] 姜中利[1] 林松[1] Ren Xiaohui;Li Haoyi;Cui Yong;Jiang Zhongli;Lin Song(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing Neurosurgical Institute,Beijing 100160,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科&北京市神经外科研究所,北京100160

出　　处：《中国医师进修杂志》2022年第8期696-699,共4页Chinese Journal of Postgraduates of Medicine

基　　金：国家自然科学基金(81771309);首都卫生发展科研专项(首发2022-2-1072)。

摘　　要：目的分析成年人下丘脑胶质瘤的临床病理特征及手术效果。方法回顾性分析首都医科大学附属北京天坛医院2011年10月至2022年1月病理证实的成年人下丘脑胶质瘤的临床病理特征和手术效果。结果成年人下丘脑胶质瘤患者32例,男女各16例,肿瘤位于下丘脑6例,下丘脑+视交叉/视神经6例,下丘脑+丘脑9例,下丘脑+三脑室11例。术前脑积水患者20例。5例行立体定向活检,27例行开颅手术切除肿瘤,11例行分流手术。27例开颅手术患者中经胼胝体入路9例,经额叶皮层造瘘入路8例,翼点入路4例,额底外侧入路4例,前纵裂入路和内镜经蝶入路各1例;全切/近全切22例,部分切除5例。32例患者均获得明确病理诊断,高级别胶质瘤9例,其中弥漫中线胶质瘤,H3K27M突变型4例,胶质母细胞瘤2例,间变星形细胞瘤3例;低级别胶质瘤23例,其中毛细胞星形细胞瘤4例,毛黏液星形细胞瘤1例,节细胞胶质瘤2例,胚胎发育不良性神经上皮肿瘤1例,胶质神经元肿瘤1例,星形细胞瘤11例,脊索样胶质瘤3例。32例患者围手术期死亡6例(18.8%),内分泌功能障碍8例,电解质紊乱7例,脑积水5例。随访0.7~110.0个月,5年总体无进展生存率为63.8%,5年总体生存率为53.9%;低级别胶质瘤患者5年无进展生存率为83.3%,5年总体生存率为72.8%。结论下丘脑胶质瘤围手术期病死率高,下丘脑功能保护至关重要,低级别胶质瘤患者可长期存活。Objective To analyze the clinic-pathological features and surgical outcomes of adult patients with hypothalamic gliomas.Methods The adult cases pathologically confirmed as hypothalamic gliomas were analyzed from October,2011 to January,2022 in Beijing Tiantan Hospital.Results There were 32 adult cases with hypothalamic gliomas,including 16 males and 16 females.Tumor was located in the hypothalamus in 6 cases,in the hypothalamus plus optic chiasma/nerve in 6 cases,in the hypothalamus plus thalamus in 9 cases,and in the hypothalamus plus the third ventricle in 11 cases.Pre-operative hydrocephalus was found in 20 cases.Five patents underwent stereotactic biopsy,27 patients underwent craniotomy,and 11 patients underwent shunt surgery for hydrocephalus.Of 27 patients with craniotomy,trans-callosal approach was chosen for 9 patients,trans-cortical for 8 patients,via pterion approach for 4 patients,via lateral sub-frontal approach for 4 patients,via fissurae interhemisphaerica for 1 patient,and trans-sphenoidal approach for 1 patient.Twenty-two patients received gross-total or subtotal resection,5 patients received partial resection.All the patients were pathologically confirmed,including 9 patients with high-grade and 23 patients with low-grade gliomas.Six patients died within 3 months after craniotomy,8 patients suffered from endocrine dysfunction,7 patients suffered from electrolyte disturbance,and 5 patients suffered from hydrocephalus.They were followed for 0.7-110.0 months,with 5-year progression-free survival rate of 63.8%and 5-year overall survival rate of 53.9%for all patients.The 5-year progression-free survival rate was 83.3%and the 5-year overall survival rate was 72.8%for low-grade gliomas.Conclusions The peri-operative mortality is high for adult patients with hypothalamic gliomas,and protection of the hypothalamic function is important.Patients with low-grade hypothalamic gliomas have good prognoses.

关 键 词：下丘脑胶质瘤 成人 临床病理 手术 疗效 

分 类 号：R739.41[医药卫生—肿瘤]