脊髓髓内星形细胞瘤诊断与手术治疗

目的探讨脊髓髓内星形细胞瘤的诊断、手术方法,并评价其预后。方法回顾性分析32例髓内星形细胞瘤的临床资料,临床表现为肢体疼痛及神经功能障碍。均采用显微手术治疗。结果低级别星形细胞瘤21例,其中全切除13例,次全切除8例;恶性星形细胞瘤11例,其中次全切除4例,部分切除7例。11例恶性星形细胞瘤病人术后均接受放疗。术后随访12~48个月,平均36.9个月。低级别星形细胞瘤中,神经功能改善15例,无变化5例,加重1例;恶性星形细胞瘤中,神经功能改善5例,无变化4例,死亡2例。结论低级别的星形细胞瘤大多能达全切除,恶性星形细胞瘤因界限不清,仅能部分或大部分切除。星形细胞瘤的病理分级、术前神经功能状态、切除程度与病人预后相关。恶性星形细胞瘤应予术后放疗。

Diagnosis and surgery treatment of intramedullary astrocytoma

Objective To explore diagnosis and surgical method of intramedullary astrocytoma in the spinal cord,and evaluate the prognosis.Methods Clinical data of 32 patients with intramedullary astrocytoma were analyzed retrospectively.The clinical feature was limb pain and neurological dysfunction.Microsurgery was performed in all the patients.Results In 21 low grade astrocytomas,total removal was achieved in 13 and subtotal in 8,while in malignant astrocytomas in 11 cases,subtotal removal was achieved in 4 and partial in 7.Eleven patients with malignant astrocytoma received radiation therapy postoperatively.All the patients were followed up for median period of 36.9 months,ranged from 12 to 48 months.Neurological function was improved in 15 patients,unchanged in 5 and aggravated in 1 with low grade astrocytoma,and improved in 5,unchanged in 4 and died in 2 with malignant astrocytoma.Conclusions Total removal can be achieved in most of low grade astrocytomas.But only partial or subtotal removal can be achieved in malignant astrocytoma with an unclear boundary.Prognosis of astrocytoma correlates with histological grade of tumor,preoperative neurological function and extent of resection.The patient with malignant astrocytoma should receive radiotherapy.