【摘要】 目的 分析颅咽管瘤术前泌乳素（PRL）、促甲状腺激素（TSH）和促肾上腺皮质激素（ACTH）的变化，探讨术前激素变化与术后尿崩症的关系，为术后并发症的防治及预后的评估提供参考依据。 方法 对2003年3月-2007年6月收治的96例颅咽管瘤患者进行回顾性分析。对患者术前的激素（PRL、TSH及ACTH）检测结果与术后尿崩症的关系进行分析；按照术前有异常的激素种类将患者分为Ⅰ组（术前无激素的改变）、Ⅱ组（术前有任意1种激素发生改变）、Ⅲ组（术前有任意2种激素发生改变）及Ⅳ组（术前3种激素都发生改变）组。分析不同组别与术后尿崩症的关系。 结果 术前PRL、TSH及ACTH有改变的患者术后尿崩症发生率高于术前上述激素无改变的患者，PRL、TSH及ACTH发生改变的种类越多，术后尿崩症发生率越高。 结论 术前PRL、TSH及ACTH的改变和改变的种类多少可以作为判定术后并发症和评估预后的参考指标之一。【Abstract】 Objective To observe the changes of prolactin (PRL), thyroid stimulating hormone (TSH), and adrenocorticotropic hormone (ACTH) in patients with craniopharyngiomas before surgery; and to analyze the relationship between their changes and incipidus after the surgery to get the basis for postoperative complications and prognosis. Methods Ninety-six patients with craniopharyngiomas from March 2003 to July 2007 were seleted. The relationship between endocrine changes before surgery and diabetes insipidus after surgery was analyzed. The patients were divided into four groups:no endocrine changed in group Ⅰ, one hormone changed in group Ⅱ, two hormones changed in group Ⅲ, and all the three hormones changed in group Ⅳ. The relationship between different groups and diabetes insipidus was analyzed. Results The pre-operative endocrine abnormalities was the sign of hypothalamus injury. There were significantly higher incidences of diabetes insipidus after the surgery in patients with endocrine abnormalities than that in the patients without any endocrine changes. There were significantly different incidence of diabetes insipidus after the surgery in different groups. Conclusion The pre-operative endocrine changes can be the guideline to predict the postoperative diabetes insipidus and to evaluate the prognosis.
目的：探讨松果体区肿瘤的治疗策略。方法:我院自2003年12月至2007年12月收治的58例松果体区肿瘤，按肿瘤标志物甲胎蛋白（AFP）和人β促绒膜性腺激素（hCG-β）将其分为标志物增高组和正常组，回顾分析两组临床资料和治疗体会。结果:肿瘤标志物正常组36例，其中27例行手术切除肿瘤，9例行伽马刀治疗（其中5例行伽马刀加脑室腹腔分流治疗）。术后4例因病理报告示生殖细胞瘤行伽马刀补充治疗，3例因梗阻性脑积水行脑室腹腔分流。增高组22例，均选用伽马刀治疗（其中17例合并梗阻性脑积水者行伽马刀加脑室腹腔分流）。治疗后3例因症状缓解不佳行手术切除肿瘤术。手术病例中24例采用经胼胝体入路，4例经枕部小脑幕入路，2例经幕下小脑上入路。手术全切24例，次全切5例，部分切除1例，术后住院期内死亡者1例。病理诊断:生殖细胞瘤14例，畸胎瘤5例，中枢神经细胞瘤4例，室管膜瘤2例，表皮样囊肿2例，脑膜瘤1例，胶质瘤1例，皮样囊肿1例。放射外科治疗病例中28例术后3个月临床症状明显改善，4例随访期内肿瘤无明显变化，3例肿瘤增大。2例放疗后出现鞍区转移。结论:松果体区肿瘤组织类型多样，应尽可能先明确肿瘤性质后选择合理治疗策略。
目的:探讨鞍区肿瘤的临床特点、手术治疗及效果。方法:回顾性分析85例接受手术的鞍区肿瘤患者的临床资料。结果:全切73例,次全切8例,大部切除4例,术后死亡1例,随访76例3个月～2年,复发或残留生长5例,4例接受γ刀治疗,1例再次手术。结论:鞍区肿瘤的发病率高,种类多样,临床表现复杂,根据肿瘤的特点选择合适的手术方式是提高切除率和改善预后的关键。
【摘要】 目的 探讨成人幕上低级别胶质瘤（WHO Ⅱ级）患者术后生活质量的影响因素。 方法 回顾性分析2008年10月—2010年5月经手术切除病变、术后病理证实为低级别胶质瘤的115例患者临床资料，术后随访6~24个月。以患者年龄、性别、主要临床症状、病变部位、病变大小及病理结果为自变量，以术后Karnofsky评分（KPS）改善为因变量，采用Logistic回归分析研究相关影响因素。采用秩和检验比较不同组间KPS差异。 结果 随访至术后6个月，患者年龄、病变大小、病变部位、切除范围以及是否有癫痫史在KPS比较中，其结果有统计学意义（Plt;0.05）。随访至术后12个月，切除范围和癫痫史对KPS评分已无影响（Pgt;0.05）。病理类型、术前是否存在神经功能障碍与术后KPS改善在单因素和多因素比较中无统计学意义。 结论 患者年龄≤50岁、术前有癫痫史、肿瘤直径≤4 cm、病变表浅、肿瘤全切除的患者术后KPS改善好于年龄gt;50岁、术前无癫痫史、肿瘤直径gt;4 cm、病变深在、肿瘤次全切除的患者。患者术前是否存在神经功能障碍和病理类型与术后生活质量是否改善无明显关系。复发也是影响患者术后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.
目的 探讨水通道蛋白4（AQP4）在脑胶质瘤性脑水肿的分子调节机制及与血管内皮生长因子（VEGF）的关系。 方法 收集2007年10月-2008年6月间65例脑胶质瘤患者手术切除新鲜肿瘤标本（胶质瘤Ⅰ级6例、Ⅱ级18例、Ⅲ级11例、Ⅳ级30例）。应用免疫荧光细胞化学方法检测肿瘤组织中AQP4蛋白和VEGF蛋白的阳性表达情况，并分析AQP4和VEGF的表达差异与关系。 结果 免疫荧光细胞化学法染色显示，AQP4蛋白在正常脑组织中主要表达于细胞膜表面，胞浆和细胞核着色较浅。在胶质瘤细胞内，AQP4广泛分布于胞浆内；肿瘤中AQP4表达和VEGF呈正相关（r=0.877，P=0.000）。 结论 在胶质瘤性脑水肿中，AQP4在胶质瘤细胞内主要分布于胞浆内，且与VEGF呈明显正相关。
Objective To investigate the cl inical features of mal ignant melanoma (MM) in the central nervous system (CNS) and to improve the diagnosis and treatment of this disease. Methods Seven MM-in-CNS patients’ records between September 1996 and April 2007 were analyzed retrospectively, including 6 males and 1 female aged 18-74 years. The 5 cases were located in the supra-tentorial area, 1 in the spinal cord and 1 in the whole brain. CT or MRI scan was appl ied. The lesion was in the right frontal area in 4 cases, in the right temporal are in 1 case, in the left temporal area in 1 case, in the left apex area in 1 case and in the cervical spinal cord of C5-7 in 1 case. Six patients underwent neurosurgical operation and1 patient received the Gamma Knife therapy. The pathological examination revealed that 2 cases were metastatic MM and 5 were primary. Results One patient with primary MM received no follow-up, and the rest 6 patients were followed up for 2 weeks to 2 years with the time of median 8 months. One patient with metastatic MM died 2 months after operation, 1 patient to with metastatic MM died 2 weeks after Gamma-Knife treatment, 1 patient with metastatic MM with primary MM died 2 years after operation, and 3 patients with primary MM were still al ive and self-independent 6, 10 and 24 months after operation, respecti vely. Conclusion Since MM-in-CNS is short of specificity in cl inical symptoms and signs, its diagnosis mainly rel ies on the pathological examination and is assisted by MRI. The combined therapy giving priority to operation is recommended.
目的 探讨经胼胝体-穹窿间入路切除第三脑室肿瘤术后，近期下丘脑反应的发生情况及相关因素，为防治第三脑室肿瘤术后下丘脑反应提供参考。 方法 回顾分析2003年1月－2008年12月经胼胝体-穹窿间入路切除的78例第三脑室肿瘤患者手术后近期（1个月内）下丘脑反应的发生情况，并将其按照肿瘤部位、病理性质、大小、血供、手术切除程度进行分类统计，用SPSS 13.0软件logistic 回归分析影响这些并发症的因素。 结果 78例术后下丘脑反应37例，发生率47.4%；死亡5例，下丘脑反应病死率为13.5%（5/37）。其中电解质糖代谢紊乱33例（42.3%），尿崩症27例（34.6%），激素水平低下16例（20.5%），高热6例（7.7%）。好转痊愈率：激素水平低下43.7%，其余均＞70%。第三脑室前部颅咽管瘤术后最容易发生下丘脑反应（P＜0.05）。 结论 经胼胝体-穹窿间入路切除第三脑室肿瘤术后近期存在程度不同的下丘脑反应，其发生与肿瘤部位、病理性质有密切关系。经积极治疗，大部分下丘脑反应能在术后1个月内好转甚至痊愈。