本文選題：海綿竇海綿狀血管瘤 + 立體定向放射治療　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本文通過對(duì)符合納入標(biāo)準(zhǔn)的有關(guān)立體定向放射治療海綿竇海綿狀血管瘤(cavernous sinus hemangiomas,CSHs)的文獻(xiàn)進(jìn)行薈萃分析,對(duì)立體定向放射外科治療在海綿竇海綿狀血管瘤治療中的有效性和安全性進(jìn)行系統(tǒng)評(píng)價(jià),從而為臨床治療方案選擇提供理論依據(jù)。方法:通過使用關(guān)鍵詞檢索及引文檢索,檢索Pub Med、Medline、Embase、OVID等數(shù)據(jù)庫(kù),納入符合標(biāo)準(zhǔn)的文獻(xiàn)并進(jìn)行數(shù)據(jù)提取。文獻(xiàn)納入標(biāo)準(zhǔn)為:文獻(xiàn)數(shù)據(jù)公開接受立體定向放射治療的CSHs患者的隨訪信息,且提供每個(gè)患者的具體信息(年齡、性別、臨床癥狀、腫瘤體積、放療劑量、隨訪時(shí)間、腫瘤控制和癥狀改善等),且為英文文獻(xiàn)。結(jié)果:納入7篇文獻(xiàn),其中6篇文獻(xiàn)關(guān)于伽馬刀放射治療,1篇文獻(xiàn)關(guān)于射波刀分次放射治療,最終得到131例CSHs患者的基本信息(包括男性39名,女性92名,平均年齡51.8歲,年齡范圍19~80歲),其中27例患者通過組織活檢確診,104例患者通過影像學(xué)檢查確診。在納入患者中,接受伽馬刀放射治療的患者有117例,接受射波刀分次放射治療的患者有14例。患者腫瘤體積范圍0.3~96.3cm3,平均(20.98±21.34)cm3。平均隨訪時(shí)間為38個(gè)月(6~164個(gè)月),最近一次影像學(xué)隨訪MRI檢查顯示:腫瘤完全消失4例(3.1%),腫瘤體積明顯縮小95例(72.5%),腫瘤體積部分縮小22例(16.8%),腫瘤體積無變化10例(7.6%)。對(duì)從文獻(xiàn)中所提取數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,結(jié)果顯示:放療后腫瘤明顯縮小或消失的患者跟腫瘤部分縮小或無變化患者相比,兩者所接受放療劑量之間有顯著差異(P=0.044)。放療前接受手術(shù)治療的患者和以放療為主要治療的患者相比,腫瘤體積縮小的程度沒有顯著差異(P=0.171)。伽馬刀放療前是否手術(shù)對(duì)神經(jīng)癥狀恢復(fù)的影響有顯著差異(P0.001),放療前未接受手術(shù)治療的患者神經(jīng)癥狀恢復(fù)更好。在巨大CSHs腫瘤控制方面,射波刀分次放射治療和伽馬刀放射治療的治療效果有顯著差異(P=0.041),且射波刀分次放射治療的療效明顯優(yōu)于伽馬刀的療效。所有患者接受放療后均未出現(xiàn)新發(fā)生的腦神經(jīng)功能損害癥狀。結(jié)論:伽馬刀放射治療前手術(shù)影響神經(jīng)系統(tǒng)癥狀恢復(fù),但對(duì)腫瘤控制無顯著影響。在巨大海綿竇海綿狀血管瘤的治療方面,射波刀分次放射治療是一種安全有效的方法,療效明顯優(yōu)于伽馬刀放射治療。立體定向放射治療可有效避免顯微外科手術(shù)治療及介入、栓塞治療的并發(fā)癥,在隨訪期內(nèi)控制腫瘤生長(zhǎng)和改善神經(jīng)系統(tǒng)癥狀的效果良好,可以作為治療海綿竇海綿狀血管瘤的主要方法,其長(zhǎng)期療效有待更進(jìn)一步研究。本文是基于非隨機(jī)觀察性研究的系統(tǒng)評(píng)價(jià),受限于樣本量少、評(píng)估治療效果無統(tǒng)一標(biāo)準(zhǔn)等因素,有待進(jìn)一步隨機(jī)對(duì)照研究為本病治療策略的選擇提供臨床依據(jù)。
[Abstract]:Objective: to conduct a meta-analysis of the literature on stereotactic radiotherapy for cavernous sinus hemangiomatous cavernous hemangioma of cavernous sinus cavernous hemangioma (CSHs) according to the inclusive criteria. The efficacy and safety of stereotactic radiosurgery in the treatment of cavernous hemangioma of cavernous sinus were systematically evaluated. Methods: the database of Pub Medline Medline Embase OVID was retrieved by keyword retrieval and citation retrieval. The literature inclusion criteria were as follows: the literature data were followed up for CSHs patients who received stereotactic radiotherapy, and specific information was provided for each patient (age, sex, clinical symptoms, tumor volume, radiotherapy dose, follow-up time). Tumor control and symptom improvement, and so on, and is English literature. Results: seven articles were included, including 6 articles on gamma knife radiotherapy and 1 document on radiosurgery. The basic information of 131 patients with CSHs was obtained, including 39 males and 92 females, with an average age of 51.8 years. The age range was 1980 years old, of which 27 cases were diagnosed by biopsy. 104 cases were diagnosed by imaging examination. Of these patients, 117 received gamma knife radiotherapy and 14 received wave knife fractionation radiotherapy. The tumor volume ranged from 0.3 to 96.3cm ~ (3), with an average of 20.98 鹵21.34 cm ~ (3). The average follow-up time was from 6 months to 164 months. The most recent imaging follow-up MRI showed that tumor disappeared completely in 4 cases, tumor volume decreased significantly in 95 cases, tumor volume decreased in 22 cases, and tumor volume did not change in 10 cases. The data extracted from the literature were statistically analyzed. The results showed that there was a significant difference in the dose of radiotherapy between the patients with significantly reduced or vanishing tumor after radiotherapy and the patients with partial or no change of tumor. There was no significant difference in the reduction of tumor volume between the patients undergoing surgery before radiotherapy and those who were treated mainly by radiotherapy. There was significant difference in the effect of gamma knife operation on the recovery of neurological symptoms before radiotherapy, and the recovery of neurological symptoms was better in the patients who did not receive surgical treatment before radiotherapy. In the control of giant CSHs tumor, there were significant differences between radiosurgery and Gamma knife radiotherapy, and the curative effect of radiosurgery was better than that of Gamma knife. No new symptoms of neurological impairment were found in all patients after radiotherapy. Conclusion: before gamma knife radiotherapy, the recovery of nervous system symptoms was affected, but the tumor control was not significantly affected. In the treatment of giant cavernous hemangioma, radiosurgery is a safe and effective method, and the curative effect is better than gamma knife radiotherapy. Stereotactic radiotherapy can effectively avoid the complications of microsurgical treatment, interventional therapy and embolization, and can control tumor growth and improve nervous system symptoms during the follow-up period. It can be used as the main method for the treatment of cavernous hemangioma of cavernous sinus. This paper is based on the systematic evaluation of non-random observational studies, which is limited by the lack of sample size and the lack of unified criteria for evaluation of therapeutic effects. Further randomized controlled studies are needed to provide clinical basis for the selection of treatment strategies for the disease.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.4

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