摘要目的 探讨外科显微手术切除后瘤床内植入5-氟尿嘧啶(5-Fu)多聚缓释体局部化疗联合125Ⅰ粒子局部增敏放疗治疗恶性脑胶质瘤的临床疗效.方法 对65例脑胶质瘤患者行开颅显微手术切除,术中于瘤床周围植入5-Fu多聚缓释体和125Ⅰ粒子,术后(3个月～1年)立体定向引导下再次植入1～2次.随访6～36个月,观察疗效、瘤周水肿情况和患者不良反应.并与同时期经随访的40例接受显微镜下全切后常规放化疗的脑胶质瘤患者相比较.结果 术后1周内患者头痛明显,脑脊液WBC不同程度升高,瘤周水肿较单纯手术明显,经治疗所有患者都顺利出院.44例患者获完全随访,生存期明显延长,半年内复发4例(9.1%),无死亡;1年内复发14例(31.8%),无死亡;2年内复发20例(45.5%),死亡12例(27.6%);3年内复发29例(65.9%),死亡20例(45.5%).未发现明显的不良反应,患者生存质量得到明显改善.结论 显微镜下手术全切肿瘤是治疗的关键,术后于瘤床内植入5-Fu多聚缓释体局部化疗联合125Ⅰ局部增敏放疗,是一种可供选择的治疗人类脑恶性胶质瘤的安全有效方法.

abstractsObjective To investigate the efficacy of treatment on malignant intracranial gliomas with the chemotherapy of intracerebral implantation of 5-Fu biodegradable polymers combined with radiotherapy of interstitial implantation of 125Ⅰ after microsurgery resection. Methods Sixty-five patients with malignant intracranial gliomas who had underwent craniotomy microsurgical resection were intraoperatively implanted in the tumor bed around with 5-Fu biodegradable polymers and 125Ⅰ seeds. After first implantation (3 months to 1 year), stereotactic guided implantation was carried out 1 or 2 times again. The patients were followed up for 6-36 months to observe the efficacy, edema and adverse reactions, compared with follow-up of 40 patients with malignant intracranial gliomas treated by conventional radiotherapy and chemotherapy after microsurgical total resection. Results Within 1 week after the implantation the patients had headache significantly, WBC of cerebrospinal fluid was increased to some degrees, and edema was obvious compared with surgery alone. All patients were treated and discharged. Forty-four patients were completely followed-up and the survival period was significantly longer. Within 6 months, 1 year, 2 years and 3 years, there were 4 cases (9.1 %) of recurrence and no case of death, 14 cases (31.8 %) of recurrence and no case of death, 20 cases (45.5 %) of recurrence and 12 cases (27.6 %) of death and 29 cases (65.9 %) of recurrence and 20 cases(45.5 %) of death, respectively. No obviously adverse reactions were found and the quality of life was significantly improved. Conclusion Microsurgical total resection is the key of the treatment. It is an alternative treatment of human malignant gliomas in the safe and effective way that the local chemotherapy of intracerebral implantation of 5-Fu biodegradable polymers combined with local sensitivity radiotherapy of interstitial implantation of 125Ⅰ after microsurgical resection.