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脊髓间变性星形细胞瘤显微外科手术疗效分析

Clinical effects of microsurgery in spinal cord anaplastic astrocytoma

摘要:

目的 探讨脊髓间变性星形细胞瘤患者的显微外科手术治疗效果及预后.方法 回顾性分析2008年1月至2015年5月于首都医科大学附属北京天坛医院神经外科行显微外科手术治疗的27例脊髓间变性星形细胞瘤患者资料,男性18例,女性9例,年龄5~52岁,平均(30.7±13.0)岁.肿瘤累及2~8个椎体节段,平均(3.3±1.3)个,颈段8例,胸段9例,颈胸段均累及3例,胸腰段均累及7例.发病至手术时间3 d至48个月,中位数4个月.临床表现包括肢体肌力下降(23例)、感觉功能障碍(22例)、疼痛(20例)、大小便功能障碍(15例)、肢体瘫痪(7例).术前脊髓功能状态按改良McCormick分级:Ⅱ级6例,Ⅲ级7例,Ⅳ级7例,Ⅴ级7例.所有患者均行显微外科手术,采取后正中入路充分暴露病变部位,沿肿瘤周边分块切除肿瘤组织,依据电生理等监测结果行最大安全范围切除,人工硬膜减张缝合、去椎板减压、硬膜外放置引流管.术后病理明确后均建议患者进一步放化疗,定期随访及复查.采用Log-rank检验比较患者的生存率差异.结果 所有患者均手术成功,无手术相关并发症,术后脊髓功能无恶化.18例患者肿瘤大部切除或近全切除,9例部分切除.术后7例患者因身体状况差或经济原因无法行放化疗,其余20例患者行放疗和(或)化疗.末次随访时仅8例存活,其余19例患者均死亡.术后总体中位生存期23.2个月(2~61个月),术后1年和2年生存率分别为85.2%和50.0%.大部切除组与部分切除组患者之间生存率的差异无统计学意义(χ2=0.089,P=0.880),与未放疗组和未化疗组相比,放疗组和化疗组患者的生存时间明显延长,差异有统计学意义(χ2=6.687,P=0.001;χ2=14.887,P=0.002).结论 脊髓间变性星形细胞瘤发病率低、病情重、疾病进展快,虽经手术及放化疗等综合治疗,预后仍较差.建议早期手术,减轻瘤负荷、改善脊髓压迫症状,术后进一步行放化疗等综合治疗,延长患者生存期.

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abstracts:

Objective To investigate the surgical outcomes and prognosis of spinal cord anaplastic astrocytoma (AA). Methods A total of 27 consecutive patients diagnosed as spinal cord AA between January 2008 and May 2015 in Department of Neurosurgery of Beijing Tiantan Hospital were retrospectively reviewed. There were 18 males and 9 females, the mean age was (30.7±13.0) years (ranging from 5 to 52 years). The lesions were located at cervical level in 8 patients, at thoracic level in 9 patients, at cervicothoracic level in 3 patients, and at thoracolumbar level in 7 patients, the average number of vertebral was 3.3±1.3.The median time from onset of symptom to surgery was 4 months, ranging from 3 days to 48 months. The clinical presentations were weakness (23 cases), paresthesia (22 cases), pain (20 cases), sphincter disorder (15 cases) and paralysis (7 cases). The preoperative modified McCormick scale was as follows: grade Ⅱ for 6 cases, grade Ⅲ for 7 cases, grade Ⅳ for 7 cases, grade Ⅴ for 7 cases.The tumors were surgically removed via posterior median approach with the monitoring of the somatosensory-evoked potentials to minimize the neurological injury. All of the patients were recommonded to receive adjuvant chemotherapy and radiotherapy postoperatively after pothological verified and followed up by clinic interview or telephone postoperatively. Log-rank test was used to calculate the survival rate. Results Gross total resection and subtotal resection were achieved in 18 patients and partial resection in 9. Twenty patients received adjuvant chemotherapy and (or) radiotherapy, 7 patients did not received chemoradiation postoperatively. Nineteen patients died and 8 were alive at the last follow-up. The median survival time was 23 months with 1 and 2-year survival rates of 85.2% and 50.0%.There was no statistical significance between subtotal resection group and partial resection group(χ2=0.089, P=0.880), the survival rates of patients in chemotherapy group and radiotherapy group were increased significantly(χ2=6.687, P=0.001;χ2=14.887, P=0.002). Conclusions Spinal cord AA is a rare spinal high-grade astrocytoma with aggressive nature, the prognosis remains poor even after comprehensive treatments. Microsurgery followed by adjuvant chemoradiation is recommended for the treatment.

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作者: 张亮 [1] 贾文清 [2] 孔德生 [2] 张志峰 [2] 杨俊 [2]
第一作者: 张亮
作者单位: 首都医科大学附属北京康复医院神经外科 [1] 100050首都医科大学附属北京天坛医院神经外科 [2]
期刊: 《中华外科杂志》2017年55卷6期 441-445页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2017.06.008
发布时间: 2017-06-30
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