CAJ | 학술논문

目的：探讨脑胶质瘤病的影像学诊断特点及不同手术方式的疗效。方法回顾性分析2008年9月-2013年9月安徽医科大学附属省立医院神经外科收治的26例脑胶质瘤病患者，术前行头颅CT、MR等多模态影像学检查，11例行立体定向多靶点活体组织检查术，15例行大骨瓣开颅脑叶切除术，术后选择放射治疗和（或）替莫唑胺化疗，随访分析立体定向活体组织检查和开颅脑叶切除术两组患者的生存期差异。结果根据多模态神经影像学表现，脑胶质瘤病分为两型：（1）Ⅰ型（19例）表现为以胼胝体为中心的侵犯多个脑叶或脑区的弥漫性、浸润性病变，增强扫描无明显强化；（2）Ⅱ型（7例）表现为在Ⅰ型的基础上，增强扫描时出现散在或结节状强化。病理学类型：毛细胞型星形细胞瘤2例、弥漫性星形细胞瘤13例、少突胶质细胞瘤3例，少突-星形细胞瘤1例、间变性星形细胞瘤5例、胶质母细胞瘤2例；肿瘤的恶性程度越高，术后生存期越短，其中开颅脑叶切除术组的术后平均生存期（23±7）个月，明显长于立体定向手术活体组织检查组（13±3）个月（P＜0.05）。结论脑胶质瘤病是一种弥漫性、浸润性生长又保留神经系统大体结构的脑内原发性胶质性肿瘤，多模态神经影像学结合病理检查可以明确诊断；手术结合放、化疗的综合治疗可以提高患者的生存时间。
목적：탐토뇌효질류병적영상학진단특점급불동수술방식적료효。방법회고성분석2008년9월-2013년9월안휘의과대학부속성립의원신경외과수치적26례뇌효질류병환자，술전행두로CT、MR등다모태영상학검사，11례행입체정향다파점활체조직검사술，15례행대골판개로뇌협절제술，술후선택방사치료화（혹）체막서알화료，수방분석입체정향활체조직검사화개로뇌협절제술량조환자적생존기차이。결과근거다모태신경영상학표현，뇌효질류병분위량형：（1）Ⅰ형（19례）표현위이변지체위중심적침범다개뇌협혹뇌구적미만성、침윤성병변，증강소묘무명현강화；（2）Ⅱ형（7례）표현위재Ⅰ형적기출상，증강소묘시출현산재혹결절상강화。병이학류형：모세포형성형세포류2례、미만성성형세포류13례、소돌효질세포류3례，소돌-성형세포류1례、간변성성형세포류5례、효질모세포류2례；종류적악성정도월고，술후생존기월단，기중개로뇌협절제술조적술후평균생존기（23±7）개월，명현장우입체정향수술활체조직검사조（13±3）개월（P＜0.05）。결론뇌효질류병시일충미만성、침윤성생장우보류신경계통대체결구적뇌내원발성효질성종류，다모태신경영상학결합병리검사가이명학진단；수술결합방、화료적종합치료가이제고환자적생존시간。
Objective To explore the neuroimaging diagnosis and therapeutic efficacy of different surgical methods of gliomatosis cerebri.Methods 26 cases of gliomatosis cerebri at our department between September 2008 and September 2013 were retrospectively analyzed.Preoperative cranial computed tomography ( CT) , magnetic resonance imaging ( MRI) and other multimodal imaging scans were performed.The procedures included stereotactic brain biopsy (n=11) and large craniotomy lobotomy (n=15).Whole brain radiotherapy and/or temozolomide therapy was performed postoperatively according to the malignancy of tumors.Follow-ups were conducted to analyze the survival differences between stereotactic brain biopsy and large craniotomy lobotomy groups.Results According to the different features of multimodal imaging , gliomatosis cerebri could be divided into two types:(1) typeⅠ(n=19) showed a diffuse infiltrating lesion infringing multiple brain lobes or regions with central corpus callosum but without obvious enhancement ;(2) type Ⅱ( n =7 ) appeared as sporadic or tuberous enhancement in addition to the features of type Ⅰ.Pathological diagnosis:pilocytic astrocytoma (n=2), diffuse astrocytoma (n=13), oligodendroglial tumors (n=3), oligoastrocytoma (n=1), anaplastic astrocytoma (n=5) and glioblastoma (n=2).The degree of malignancy was a prognostic factor for postoperative survival in patients with gliomatosis cerebri .The mean survival time ( MST ) of large craniotomy lobotomy group ( 23 ±7 ) was significantly longer than that of stereotactic brain biopsy group(13 ±3)(P<0.05).Conclusion Gliomatosis cerebri is a primary brain glial tumor with diffuse infiltrative growth but retaining the general structure of central nervous system .Multimodal imaging studies plus pathological examination yield a definitive diagnosis.Comprehensive treatment of operation plus chemo-or radio-therapy can prolong postoperative MST.