【摘要】 目的 探討成人幕上低級別膠質瘤（WHO Ⅱ級）患者術后生活質量的影響因素。 方法 回顧性分析2008年10月—2010年5月經手術切除病變、術后病理證實為低級別膠質瘤的115例患者臨床資料，術后隨訪6~24個月。以患者年齡、性別、主要臨床癥狀、病變部位、病變大小及病理結果為自變量，以術后Karnofsky評分（KPS）改善為因變量，采用Logistic回歸分析研究相關影響因素。采用秩和檢驗比較不同組間KPS差異。 結果 隨訪至術后6個月，患者年齡、病變大小、病變部位、切除范圍以及是否有癲癇史在KPS比較中，其結果有統計學意義（Plt;0.05）。隨訪至術后12個月，切除范圍和癲癇史對KPS評分已無影響（Pgt;0.05）。病理類型、術前是否存在神經功能障礙與術后KPS改善在單因素和多因素比較中無統計學意義。 結論 患者年齡≤50歲、術前有癲癇史、腫瘤直徑≤4 cm、病變表淺、腫瘤全切除的患者術后KPS改善好于年齡gt;50歲、術前無癲癇史、腫瘤直徑gt;4 cm、病變深在、腫瘤次全切除的患者。患者術前是否存在神經功能障礙和病理類型與術后生活質量是否改善無明顯關系。復發也是影響患者術后KPS改善的因素。【Abstract】 Objective To assess the quality of life in adults with surgically managed cerebral supratentorial low grade glioma (WHO grade Ⅱ) and the relevant factors. Methods We retrospectively analyzed the clinical data of 115 patients with histologically proven supratentorial low grade glioma enrolled at West China Hosptial from October 2008 to May 2010. Follow-up lasted for 6 to 24 months after operation. Logisitc regression analysis is used to test the relevant factors with age, gender, main clinical manifestations, lesion location, lesion size and pathological results as the independent variables, and Kamofsky postoperative scale (KPS) scores as dependent variable. KPS scores of different groups were analyzed using the rank test. Results After 6 months of follow-up, we found that age, size, location, extent of surgical excision and eplispy history showed a statistical significance in KPS comparison (Plt;0.05). Till the 12th month in the follow-up, the extent of surgical excision and eplispy history were not statistically significant any more (Pgt;0.05). Histology type and neurological deficit had no relationship with KPS improvement in both single factor analysis and multivariate analysis. Conclusions Patients with an age older than 50 years, preoperative epilepsy history, the largest diameter of the tumor less than 4 cm, shallow lesions, and complete tumor resection have a better KPS improvement after operation than those with corresponding opposite conditions. There is no obvious relationship between histology type, neurologic deficits and KPS improvement after operation. Recurrence is also a factor influencing KPS improvement after operation.
【摘要】 目的 探討顱內原發生殖細胞瘤的臨床特征。方法 收集華西醫院腦外科2000年1月—2009年3月119例顱內原發生殖細胞瘤的臨床資料進行回顧性分析。結果 發病率約占同期顱內腫瘤的 1.1%。男〖DK〗∶女=1.64〖DK〗∶1,平均發病年齡15.4歲。臨床表現主要為顱內高壓癥狀及視力視野改變,分別為61、56例；腫瘤主要來源于松果體區及鞍區；64例患者行放療或放療加化療,隨訪45例。55例患者行手術治療(其中術后行單純放療19例,放療加化療5例),隨訪36例。隨訪時間3~94個月,平均29.7個月。行放療和放化療的患者3、5年生存率明顯高于單純行手術治療的患者。結論 顱內原發生殖細胞瘤多見于兒童及青少年,男性多見,腫瘤大多位于松果體區及鞍區。臨床表現位于松果體區者主要為顱內高壓癥狀等,位于鞍區者主要為視力視野改變、尿崩等。放療聯合化療是主要治療手段。