CAJ | 학술논문

目的：分析头颈部神经纤维瘤的手术方式、复发及预后情况，探讨其治疗策略。方法回顾性分析46例神经纤维瘤的临床资料，其中41例患者获得有效随访。分析头颈部神经纤维瘤患者的临床病理特征、手术方式、治愈情况和神经功能。结果41例获得有效随访的患者中，治愈26例，未治愈15例（其中死亡2例）。伴有和不伴有Ⅰ型神经纤维瘤病的神经纤维瘤患者的治愈率分别为42．9％和85．0％，差异有统计学意义（ P＝0．005）。局限型、侵袭型、弥漫型和串珠型患者的治愈率分别为100．0％、46．6％、40．0％和66．7％，差异有统计学意义（ P＝0．009）。肿瘤彻底切除（包括扩大切除和完整切除）和部分切除患者的治愈率分别为73．5％和14．3％，差异有统计学意义（P＝0．011）。扩大切除与部分切除患者的治愈率分别为80．0％和14．3％，差异有统计学意义（ P＝0．029）。完整切除患者的治愈率为70．8％，与部分切除患者比较，差异有统计学意义（P＝0．026）。但完整切除与扩大切除患者的治愈率差异无统计学意义（ P＝0．581）。 Cox多因素回归分析显示，肿瘤切除彻底与否是影响神经纤维瘤患者预后的独立因素。结论神经纤维瘤是具有侵袭特征的良性肿瘤，部分肿瘤复发率高、治愈率低，且术后神经损伤常难以避免，术后神经功能与预后受多种因素影响，因此需慎重选择手术时机及手术方式。
목적：분석두경부신경섬유류적수술방식、복발급예후정황，탐토기치료책략。방법회고성분석46례신경섬유류적림상자료，기중41례환자획득유효수방。분석두경부신경섬유류환자적림상병리특정、수술방식、치유정황화신경공능。결과41례획득유효수방적환자중，치유26례，미치유15례（기중사망2례）。반유화불반유Ⅰ형신경섬유류병적신경섬유류환자적치유솔분별위42．9％화85．0％，차이유통계학의의（ P＝0．005）。국한형、침습형、미만형화천주형환자적치유솔분별위100．0％、46．6％、40．0％화66．7％，차이유통계학의의（ P＝0．009）。종류철저절제（포괄확대절제화완정절제）화부분절제환자적치유솔분별위73．5％화14．3％，차이유통계학의의（P＝0．011）。확대절제여부분절제환자적치유솔분별위80．0％화14．3％，차이유통계학의의（ P＝0．029）。완정절제환자적치유솔위70．8％，여부분절제환자비교，차이유통계학의의（P＝0．026）。단완정절제여확대절제환자적치유솔차이무통계학의의（ P＝0．581）。 Cox다인소회귀분석현시，종류절제철저여부시영향신경섬유류환자예후적독립인소。결론신경섬유류시구유침습특정적량성종류，부분종류복발솔고、치유솔저，차술후신경손상상난이피면，술후신경공능여예후수다충인소영향，인차수신중선택수술시궤급수술방식。
Objective To investigate the surgical mode, recurrence and prognosis for patients with head and neck neurofibromas and explore their treatment strategies. Methods The clinicopathological features, operation mode, prognosis and neural function of 46 patients with head and neck neurofibroma were analyzed retrospectively, and 41 of the cases were followed up for 24?170 months ( median 74 months ) . Results Among the 41 followed?up patients, 26 patients were cured and 15 patients were not cured ( two died) . The cure rate of the neurofibromas with neurofibromatosis type 1 ( NF1 ) and the neurofibromas without NF1 were 42.9% and 85.0%, respectively (P=0.005). The cure rate of localized, aggressive, diffuse and beaded neurofibromas were 100.0%, 46.6%, 40.0% and 66.7%, respectively ( P=0.009) . The cure rate of radical resection ( including expanding excision and complete resection ) and partial resection were 73.5% and 14.3%, respectively ( P=0.011) . The cure rates of expanding excision and partial resection were 80.0% and 14.3% ( P=0.029) . The cure rates of complete resection and partial resection were 70.8%and 14.3%, respectively ( P=0.026) . However, the cure rates of expanding excision and complete resection were not significantly different (P=0.581).Multivariate Cox model analysis indicated that thoroughness of surgery was the independent risk factor for the prognosis for patients with head and neck neurofibromas. Conclusions Neurofibroma is a kind of aggressive benign tumors. Some neurofibromas have a high recurrence rate and low recovery rate, and some nerves are essay to be injured in the operation. Lots of factors impact on the prognosis and recovery of the neural function. Therefore, operation opportunity and mode should be carefully selected.