【摘要】 目的 分析顱咽管瘤術前泌乳素（PRL）、促甲狀腺激素（TSH）和促腎上腺皮質激素（ACTH）的變化，探討術前激素變化與術后尿崩癥的關系，為術后并發癥的防治及預后的評估提供參考依據。 方法 對2003年3月-2007年6月收治的96例顱咽管瘤患者進行回顧性分析。對患者術前的激素（PRL、TSH及ACTH）檢測結果與術后尿崩癥的關系進行分析；按照術前有異常的激素種類將患者分為Ⅰ組（術前無激素的改變）、Ⅱ組（術前有任意1種激素發生改變）、Ⅲ組（術前有任意2種激素發生改變）及Ⅳ組（術前3種激素都發生改變）組。分析不同組別與術后尿崩癥的關系。 結果 術前PRL、TSH及ACTH有改變的患者術后尿崩癥發生率高于術前上述激素無改變的患者，PRL、TSH及ACTH發生改變的種類越多，術后尿崩癥發生率越高。 結論 術前PRL、TSH及ACTH的改變和改變的種類多少可以作為判定術后并發癥和評估預后的參考指標之一。【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：探討松果體區腫瘤的治療策略。方法:我院自2003年12月至2007年12月收治的58例松果體區腫瘤，按腫瘤標志物甲胎蛋白（AFP）和人β促絨膜性腺激素（hCG-β）將其分為標志物增高組和正常組，回顧分析兩組臨床資料和治療體會。結果:腫瘤標志物正常組36例，其中27例行手術切除腫瘤，9例行伽馬刀治療（其中5例行伽馬刀加腦室腹腔分流治療）。術后4例因病理報告示生殖細胞瘤行伽馬刀補充治療，3例因梗阻性腦積水行腦室腹腔分流。增高組22例，均選用伽馬刀治療（其中17例合并梗阻性腦積水者行伽馬刀加腦室腹腔分流）。治療后3例因癥狀緩解不佳行手術切除腫瘤術。手術病例中24例采用經胼胝體入路，4例經枕部小腦幕入路，2例經幕下小腦上入路。手術全切24例，次全切5例，部分切除1例，術后住院期內死亡者1例。病理診斷:生殖細胞瘤14例，畸胎瘤5例，中樞神經細胞瘤4例，室管膜瘤2例，表皮樣囊腫2例，腦膜瘤1例，膠質瘤1例，皮樣囊腫1例。放射外科治療病例中28例術后3個月臨床癥狀明顯改善，4例隨訪期內腫瘤無明顯變化，3例腫瘤增大。2例放療后出現鞍區轉移。結論:松果體區腫瘤組織類型多樣，應盡可能先明確腫瘤性質后選擇合理治療策略。
目的:探討鞍區腫瘤的臨床特點、手術治療及效果。方法:回顧性分析85例接受手術的鞍區腫瘤患者的臨床資料。結果:全切73例,次全切8例,大部切除4例,術后死亡1例,隨訪76例3個月～2年,復發或殘留生長5例,4例接受γ刀治療,1例再次手術。結論:鞍區腫瘤的發病率高,種類多樣,臨床表現復雜,根據腫瘤的特點選擇合適的手術方式是提高切除率和改善預后的關鍵。
【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.
目的 探討水通道蛋白4（AQP4）在腦膠質瘤性腦水腫的分子調節機制及與血管內皮生長因子（VEGF）的關系。 方法 收集2007年10月-2008年6月間65例腦膠質瘤患者手術切除新鮮腫瘤標本（膠質瘤Ⅰ級6例、Ⅱ級18例、Ⅲ級11例、Ⅳ級30例）。應用免疫熒光細胞化學方法檢測腫瘤組織中AQP4蛋白和VEGF蛋白的陽性表達情況，并分析AQP4和VEGF的表達差異與關系。 結果 免疫熒光細胞化學法染色顯示，AQP4蛋白在正常腦組織中主要表達于細胞膜表面，胞漿和細胞核著色較淺。在膠質瘤細胞內，AQP4廣泛分布于胞漿內；腫瘤中AQP4表達和VEGF呈正相關（r=0.877，P=0.000）。 結論 在膠質瘤性腦水腫中，AQP4在膠質瘤細胞內主要分布于胞漿內，且與VEGF呈明顯正相關。
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 探討經胼胝體-穹窿間入路切除第三腦室腫瘤術后，近期下丘腦反應的發生情況及相關因素，為防治第三腦室腫瘤術后下丘腦反應提供參考。 方法 回顧分析2003年1月－2008年12月經胼胝體-穹窿間入路切除的78例第三腦室腫瘤患者手術后近期（1個月內）下丘腦反應的發生情況，并將其按照腫瘤部位、病理性質、大小、血供、手術切除程度進行分類統計，用SPSS 13.0軟件logistic 回歸分析影響這些并發癥的因素。 結果 78例術后下丘腦反應37例，發生率47.4%；死亡5例，下丘腦反應病死率為13.5%（5/37）。其中電解質糖代謝紊亂33例（42.3%），尿崩癥27例（34.6%），激素水平低下16例（20.5%），高熱6例（7.7%）。好轉痊愈率：激素水平低下43.7%，其余均＞70%。第三腦室前部顱咽管瘤術后最容易發生下丘腦反應（P＜0.05）。 結論 經胼胝體-穹窿間入路切除第三腦室腫瘤術后近期存在程度不同的下丘腦反應，其發生與腫瘤部位、病理性質有密切關系。經積極治療，大部分下丘腦反應能在術后1個月內好轉甚至痊愈。