Mu Yong-Gao, Chen Ming-Zhen, Chen Zhong-Ping, Zhou Wang-Ning, Zhang Xiang-Heng, Sai Ke
Department of Neurosurgery, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong 510 060, P.R. China.
Ai Zheng. 2004 Nov;23(11):1317-21.
BACKGROUND & OBJECTIVE: Prognosis of glioma is still poor, its main treatment is surgery. The extent of tumor resection relates with prognosis. This study was to evaluate the extent of resection, post-operative Karnofsky performance scale (KPS), and survival rate of the glioma patients received microsurgery.
Records of 183 glioma patients received microneurosurgery were retrospectively analyzed, the extent of resection, post-operative KPS, and survival rate of patients were evaluated. Different microsurgical techniques were applied according to the location of gliomas. En bloc resection was performed for gliomas in non-functional areas by dissecting the tumors along edema area with high-power bipolar electrocoagulation. The tumors in functional areas were separated along cortex sulcus, the central part of tumor was removed firstly, and residual part was resected with low-power electrocoagulation. Gliomas close to important vessels were sucked, and electrocoagulation seldom performed.
Among 183 cases of glioma, 85 in non-functional area, 47 in functional area, and 51 close to important vessels. Total and sub-total resection was performed in 163 patients (89.1%). The average post-operative KPS was 74. The KPS was decreased in 23 patients, increased in 44 patients, and stable in 116 patients. Patients were followed up for 12-216 months with an average of 47.8 months. The follow-up rate was 100%. Among 113 patients with long-term follow-up (>/=5 years), 5-year survival rates of low-grade, and high-grade astrocytoma patients were 75.4% (52/69), and 18.2% (8/44).
Using different microsurgical patterns according to location of glioma, maximal resection of tumor may achieve with protection of neurological function.
胶质瘤的预后仍然很差，其主要治疗方法是手术。肿瘤切除范围与预后相关。本研究旨在评估接受显微手术的胶质瘤患者的切除范围、术后卡氏功能状态评分（KPS）及生存率。
回顾性分析183例接受显微神经外科手术的胶质瘤患者的记录，评估患者的切除范围、术后KPS及生存率。根据胶质瘤的位置采用不同的显微手术技术。对于非功能区的胶质瘤，沿水肿区用高功率双极电凝分离肿瘤，行整块切除。功能区的肿瘤沿脑沟分离，先切除肿瘤中央部分，残留部分用低功率电凝切除。靠近重要血管的胶质瘤采用吸引法，很少用电凝。
183例胶质瘤患者中，非功能区85例，功能区47例，靠近重要血管51例。163例患者（89.1%）行全切除或次全切除。术后KPS平均为74分。23例患者KPS下降，44例患者KPS升高，116例患者KPS稳定。患者随访12 - 216个月，平均47.8个月。随访率为100%。113例长期随访（≥5年）患者中，低级别和高级别星形细胞瘤患者的5年生存率分别为75.4%（52/69）和18.2%（8/44）。
根据胶质瘤的位置采用不同的显微手术方式，在保护神经功能的同时可实现肿瘤的最大切除。
