复发脑胶质瘤再手术治疗的临床疗效

  目的  通过多模态显微外科手术在脑胶质瘤复发患者的临床疗效分析，探索脑胶质瘤复发后的诊疗模式。  方法  收集昆明某三甲医院神经外科2017年9月至2020年12月收治的术后脑胶质瘤复发后再手术的患者资料28例，进行回顾性分析，用KPS（ Karnofsky 神经功能评分）进行临床疗效评估，用影像学资料评价肿瘤切除程度、复发脑胶质瘤的病理变化对比、术后的辅助治疗、随访患者的生存期等总体疗效。通过 Graphpad Prism软件进行作图、数据分析。采用配对样本t检验，分析术前及术后KPS评分的差异。  结果  28例研究对象的术后影像学观察结果:肿瘤全切的21例，次全切的5例，肿瘤活检的2 例。并发症患者22例。出院前的临床症状较术前有所改善24例（改善率 85.7%）。术前KPS平均评分（66.07±7.37）分；术后1月KPS平均评分（72.14±11.00）分，对比术前的 KPS 评分，差异有统计学意义（P < 0.05）。患者术后病理显示肿瘤恶性程度进展8例。经术后随访证实28例患者的平均生存时间（7.98±6.42）月，最长生存时间24月。  结论  多模态、多技术联合应用的显微外科手术是复发脑胶质瘤的相对微创且有效的治疗方式，效果良好，可用作复发脑胶质瘤手术切除的选择术式。

Clinical Effect of Reoperation for Recurrent Glioma

  Objective  To analyze the clinical effect of multimodality microsurgery on recurrent gliomas, and to explore the diagnosis and treatment of recurrent gliomas.  Methods  Data of 28 patients with recurrent GLIOMAS who underwent reoperation from September 2017 to December 2020 in the Department of Neurosurgery of a tertiary grade A hospital in Kunming were collected and analyzed retrospectively, After the reoperation, the Karnofsky neurological function score （KPS） was used to evaluate the clinical efficacy, and the imaging data was used to evaluate the degree of tumor resection, the postoperative comparison of pathological changes of recurrent glioma, postoperative adjuvant treatment, follow-up patient survival time and other overall effects. Graphpad Prism （V8.4.2.679） software was used to analyze the data and graph. The difference in KPS scores before and after the operation was tested in pairs.   Results  28 patients were treated with reoperations to varying degrees. Postoperative imaging confirmed that 21 cases of tumors were totally resected, 5 cases were subtotal resected, and 2 cases had tumor biopsy. Postoperative complications occurred in 22 patients. The clinical symptoms before discharge were improved in 24 cases compared with that before the operation, with an improvement rate of 85.7%. The mean KPS score was 66.07 ± 7.37 before the operation and 72.14 ± 11.00 one month after the operation.The differences were statistically significant. Postoperative pathology showed the progression of Malignancy in 8 cases. The mean survival time of 28 patients were （7.98 ± 6.42） months and the longest survival time were 24 months.  Conclusion  The combined application of multi-modality and multi-technique microsurgery is a relatively minimally invasive and effective treatment for recurrent glioma. The surgical effect is good, and it can be used as an option for surgical resection of recurrent glioma.