复发脑胶质瘤再手术的适应证及预后影响因素

摘要

目的：探讨复发脑胶质瘤再手术的适应证及预后相关影响因素，以期为复发脑胶质瘤再手术指征的选择提供参考。方法回顾性分析44例复发脑胶质瘤行再手术治疗患者的临床资料，分析再手术适应证及预后。结果44例患者均完成手术，其中26例为全切除，18例为次全切，术后出现严重脑水肿1例，肺部感染3例，无死亡病例；患者术前K PS评分40～90分，平均（68.73±10.86）分，再手术后患者K PS评分50～90分，平均（78.93±13.84）分，其中K PS提高分值10分以上27例，提高20分10例，提高＞20～30分5例，无变化2例，患者再手术后K PS评分较手术前明显下降（ P＜0.05）；再手术后生存期4～26个月，平均（12.31±3.28）个月；单因素及多因素分析结果均显示患者自身术前K PS评分、术前分级、复发病灶手术范围、复发间隔时间是影响到患者再手术后生存期的独立因素（P＜0.05）。结论复发脑胶质瘤患者术前KPS评分、术前分级、复发病灶手术范围、复发间隔时间是影响再手术后的生存期及生存质量的主要因素，K PS≥70分、术前分级Ⅰ～Ⅱ级、复发病灶采用全切除及距离上次手术复发时间≥12个月是复发脑胶质瘤患者再手术的适应证，此时再手术有助于提高患者术后生存期及改善预后。%Objective To investigate indications and related prognostic factors in the reoperation of recurrent glioma ,in order to provide reference for surgical indications of re-recurrent glioma .Methods Clinical data of 44 reoperation patients with recurrent glioma was retrospectively analyzed .And then analyze the indications for surgery and prognostic factors .Results All patients received surgery completely ,including 26 cases of resection ,18 cases of subtotal .One patient during the postoperative hospital suffered with severe cerebral edema ,3 patients with pulmonary infection .There was no deaths appeared .KPS scores were 40-90 pre-operation ,with an average of 68 .73 ± 10 .86 .KPS scores after surgery were 50-90 ,with an average of (78 . 93 ± 13 .84) .KPS scores improved more than 10 points in 27 cases ,10 cases increased 20 points and 5 cases improved 20-30 minutes .And 2 patients had no change .KPS score after operation decreased significantly compared with before surgery (P<0 . 05) .All patients survived 4-26 months after surgery ,with the average (12 .31 ± 3 .28) months .Univariate and multivariate analysis showed KPS score before surgery ,preoperative grade ,recurrent lesion extent of surgery and the recurrence interval were independent factors affected survival time after operation (P<0 .05) .Conclusion KPS score before surgery ,preoperative grade ,recurrent lesion extent of surgery and the recurrence interval were independent factors affected survival time after opera-tion for recurrent glioma patients .KPS≥70 points ,Ⅰ-Ⅱ grade pre-operation ,recurrent lesions using surgical resection and re-currence≥12 months since the last time were appropriate indications for reoperation in recurrent glioma patients .Further sur-gery helps to improve the survival time and outcomes in these patients .