论文部分内容阅读
目的 探讨颅内肿瘤X刀治疗后再手术原因与预防、治疗方法。方法 总结 32例X刀治疗后再手术病例 ,含病变 49个 ,病变最大直径 4.0 1± 1.30cm ,体积 2 7.2 6± 2 1.6 8cm3 。取同期X刀治疗患者对比分析。结果 对 49个病变进行 38次X刀治疗 ,随访 42 .0 8± 19.82月 ,31例X刀后出现病情反复或加重 ,影像检查见瘤周水肿 30例 ,新生强化结节 5例 ,局部复发 10例 ,脑积水 6例。共接受 39次手术治疗 ,肿瘤切除 2 3例次 ,病变切除 8例次 ,去骨瓣减压 5例 ,腹腔分流 7例 ,囊肿穿刺 2例。病理见肿瘤中心及部分靶区脑组织坏死 ,伴灶性、陈旧性出血、胶质细胞增生、癍痕形成。结论 X刀治疗后再手术病残、死亡率高 ,顽固性水肿、新生强化结节、放射性坏死等脑迟发反应是X刀治疗后再手术和致残的主要原因 ,其次是肿瘤复发和脑积水等并发症。主张严格掌握X刀治疗适应证与照射剂量 ,合理使用多靶点、分次治疗 ,并有机结合传统放射与手术治疗。
Objective To investigate the causes and prevention and treatment of reoperation after intracranial tumor X knife treatment. Methods Thirty-two cases of X-knife re-operation were retrospectively reviewed, including 49 lesions. The maximum diameter of the lesion was 4.01 ± 1.30cm and the volume was 7.22 ± 2.168cm3. Take the same period X knife treatment in patients with comparative analysis. Results Fifty-nine lesions were treated with X-knife. The follow-up was 42.0 ± 19.82 months. The condition was repeated or aggravated after 31 cases of X-knife. Thirty cases of peritumoral edema were found in the imaging examination. 10 cases, 6 cases of hydrocephalus. A total of 39 surgical procedures were performed. Tumor resection was performed in 23 cases, lesion removal in 8 cases, decompressive craniectomy in 5 cases, peritoneal shunt in 7 cases and cyst puncture in 2 cases. Pathology, see the center of the tumor and some target areas of brain tissue necrosis, with focal, old bleeding, glial cell proliferation, marks formation. Conclusion X-knife reoperation after surgery, high mortality, intractable edema, neonatal nodules, radiation necrosis and other brain delayed response is the main reason for surgery and disability after X knife treatment, followed by tumor recurrence and brain Hydrocephalus and other complications. Advocating strict control of X knife treatment indications and exposure dose, the rational use of multiple targets, sub-treatment, and organic combination of traditional radiation and surgical treatment.