上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (7): 935-.doi: 10.3969/j.issn.1674-8115.2012.07.024

• 论著（临床研究） • 上一篇    下一篇

12例基底节区巨大生殖细胞瘤的治疗分析

陆兆丰1, 邱永明2, 程小兵1, 孟晓峰1   

  1. 1.河南科技大学第一附属医院神经外科, 洛阳 471001； 2.上海交通大学 医学院附属仁济医院神经外科, 上海 200001
  • 出版日期:2012-07-28 发布日期:2012-08-17
  • 作者简介:陆兆丰（1973—）, 男, 主治医师, 博士；电子信箱: zhaofenglu001@163.com。

Clinical analysis of 12 cases of giant germinoma in basal ganglia area

LU Zhao-feng1, QIU Yong-ming2, CHENG Xiao-bing1, MENG Xiao-feng1   

  1. 1. Department of Neurosurgery, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471001, China；2.Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
  • Online:2012-07-28 Published:2012-08-17

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摘要：

目的 分析肿瘤全切除结合术后超早期放疗对基底节区巨大生殖细胞瘤的治疗效果。方法 收集12例基底节区生殖细胞瘤患者的临床资料。所有患者均接受显微镜下肿瘤全切除。术后病理学检查确诊，回顾免疫组织化学检测中的特征性表现。术后5～7 d辅以单纯普通放疗（剂量：全脑照射30 Gy+局部照射20 Gy+全脊髓照射30 Gy）。观察手术前后患者临床症状和影像学表现改变以及肿瘤组织免疫组织化学检测结果。随访1年，采用Karnofsky评分法评价生活质量，并与手术前评分进行比较。结果 术后病理学检查免疫组织化学染色结果显示：肿瘤细胞胞质胎盘碱性磷酸酶（PLAP）和细胞膜和(或)胞质CD117染色阳性。治疗后所有患者颅高压症状明显缓解或消失，临床症状和体征均较术前明显改善；CT和磁共振成成像（MRI）扫描显示肿瘤组织全部切除，占位效应也明显减轻。Karnofsky生活质量评分较治疗前显著提高。结论 显微镜下肿瘤切除结合术后超早期放疗是治疗基底节区生殖细胞瘤的首选方案。

关键词: 生殖细胞瘤, 显微神经外科, 放射治疗

Abstract:

Objective To investigate the effects of microneurosurgery combined with radiotherapy in the treatment of giant germinoma in basal ganglia area. Methods The clinical data of 12 patients with giant germinoma in basal ganglia area were collected. All patients underwent total resection of tumors under microscope. The diagnosis was confirmed by pathological examinations after operation, and the characteristic findings in immunohistochemical detection were retrospectively analysed. Radiotherapy was performed 5 to 7 d after operation, with whole brain irradiation 30 Gy+local irradiation 20 Gy+whole spine irradiation 30 Gy. The changes of clinical symptoms and imaging features after operation and the results of immunohistochemical detection for tumors were observed. Patients were followed up for one year, the  quality of life was evaluated with Karnofsky scoring method, and was compared with that before operation. Results Immunohistochemical staining after operation revealed that placental alk phosphatase was positively stained in cytoplasm, and CD117 was positively stained in cytomembrane and/or cytoplasm. After treatment, the symptoms of intracranial hypertension significantly relieved or disappeared, and the clinical signs and symptoms were significant improved in all the patients. CT and magnetic resonance imaging indicated that total resection of tumors was achieved, and the space-occupying effect was significantly relieved. The quality of life evaluated by Karnofsky scoring method was much better than that before operation. Conclusion Microneurosurgery combined with radiotherapy should be the first scheme in the treatment of giant germinoma in basal ganglia area.

Key words: germinoma, microneurosurgery, radiotherapy