幕上恶性胶质瘤术后异位复发的多因素临床分析（附8例临床报告）.docVIP

精品论文 参考文献 幕上恶性胶质瘤术后异位复发的多因素临床分析（附8例临床报告） 傅强1 高志宇1 林凯1 王东臣1 祝子鹏1 孙汉宇1 刘超1 张杰2 　　【摘 要】 目的 研究幕上恶性脑胶质瘤患者手术后出现异位复发和播散转移的相关影响因素。方法 对已发现的幕上恶性胶质瘤异位复发和播散转移8例病例进行回顾性临床分析，探讨其发生发展规律。并研究患者年龄、肿瘤性质、原发部位部位、手术方式、综合治疗、发生时间等与种植转移有联系的相关因素。结果 8例中，6例为胶质母细胞瘤，2例为星形细胞瘤Ⅲ级，5例手术中将脑室打通，所有病例术后均行标准化同步放化疗及替莫唑胺六周期维持化疗。在数月内发生同侧或对侧的脑室旁亦或远隔部位肿瘤种植性转移导致病情恶化。结论 幕上脑胶质瘤种植性播散转移多发生于青壮年恶性胶质瘤患者术后6个月～1年内，与同时行替莫唑胺同步放化疗且和术中打通脑室有密切关系，故类似患者术后1年内应在较短的时间间隔内进行颅脑MRI增强扫描，以尽可能早地发现复发和播散，从而调整治疗方案，以改善脑胶质瘤患者的预后。 　　【关键词】 幕上恶性胶质瘤； 播散； 转移； 替莫唑胺同步放化疗 　　Clinical Experience of Dissemination and Metastasis of Supratentorial High Grade Glioma after Surgery 　　【Abstract】 Objective To investigate the cases with ectopic recurrence and metastases of brain glioma after surgery and their related influencing factors. Method we proceeded a retrospective clinical analysis of 8 patients that surffering recrudescent or transferred glioma, and then, we explored the pattern of development. In addition, the correlative factors on implantation metastasis were also in rearch, such as the patientsrsquo; age, the property of tumor, the primary position, the surgical method, comprehensive treatment, the medical surgery and so on. Results In the 8 clinical cases, 6 patients suffered glioblastoma, 2 patients got astroglioma (level 3), and 5 patientsrsquo; encephalocoele were opened during operation. All the patients received temozolomide and concurrent radiochemotherapy, but the ipsilateral or contralateral metastasis beside the ventricle or remoteness places exacerbated their condition. Conclusions implantation metastasis of supratentorial glioma mainly occurs in young adults 6 months- one year after the operation. And it has a close relationship with the openness of lateral ventricle and treatment of temozolomide concurrent radiochemotherapy. In conclusion, the patients with similar characters should take cerebral MRI enhancement scanning in the next year of resection operation to discover recurrence and metastases as early as po