摘要目的 探讨显微外科手术治疗丘脑胶质瘤的疗效,分析预后.方法 自201 1年12月至2015年1月,采用经顶上小叶、经胼胝体、经额叶侧脑室及经外侧裂岛叶4种手术入路治疗丘脑胶质瘤57例,术后47例同期行放(化)疗.观察术后症状及并发症情况,计算总体生存率(OS)和无疾病进展生存率(PFS),并进行单因素及多因素预后分析.结果 本组围手术期无死亡病例,39例次全切除(＞90％),18例大部切除(60％ ～ 90％),均经病理明确诊断为胶质瘤.术后症状改善40例,无改善11例,恶化6例,12例术后未出现并发症.6个月、12个月和24个月OS分别为80.4％、53.3％和28.6％,PFS分别为71.4％、41.3％和17.2％.中位生存时间和中位无进展生存时间分别为14.0个月(95％ CI:13.1 ～20.7)和12.0个月(95％ CI:9.4 ～ 14.6).多因素分析显示病理类型和治疗方式是影响OS和PFS的独立预后因素(P＜0.05).结论 手术治疗丘脑胶质瘤近期效果较好,能有效缓解症状,提高患者的生活质量,术后辅助放(化)疗可以延长患者的生存时间.

abstractsObjective To investigate the efficacy and prognostic analysis of microsurgery treatment of thalamic gliomas.Methods From December 2011 to January 2015,57 patients with thalamic gliomas were treated via parietal lobule,corpus callosum,frontal lateral ventricle,and lateral fissure insular approaches,and 47 accepted radiotherapy/chemotherapy after procedure over the same time period.The postoperative symptoms and complications were observed and the overall survival (OS),progression free survival (PFS) were calculated,and the univariate and multivariate prognostic analyses were conducted.Results No patient died during the perioperative period in this group.Subtotal resection (＞ 90％) was achieved in 39 cases and partial resection (60％-90％) was achieved in 18 cases.They were clearly diagnosed as gliomas by histopathology.The symptoms were improved in 40 cases,unchanged in 11 cases,and aggravated in 6 cases,did not have complications in 12 cases after procedure.OS of 6,12,and 24 months were 80.4％,53.3％ and 28.6％,respectively,and PFS of those were 71.4％,41.3％,and 17.2％,respectively.The median survival time and the median progression-free survival time were 14.0 months (95％ CI 13.1-20.7) and 12.0 months (95％ CI 9.4-14.6) respectively.Multivariate analysis showed that the pathological types and the treatment modalities were the independent prognostic factors for affecting OS and PFS (P ＜0.05).Conclusions The effect of surgical treatment of thalamic gliomais is better recently.It can effectively relieve symptoms and improve the quality of life of patients.The postoperative adjuvant radiotherapy/chemotherapy may prolong the survival time of patients.