李敖患脑干胶质瘤辞世 长期染发等是致病因素

2018-03-19 卞留贯 文汇

昨日,著名作家李敖先生不幸因病撒手人寰。台北“荣总”医院代家属发出说明稿表示,李敖于2015年7月因步态不稳至医院求诊,经诊断为脑干肿瘤,在医疗团队的努力下,接连度过难关。根据李敖先生身前的采访以及家属声明,可以得知李敖先生所患的疾病为脑干胶质瘤。其实胶质瘤是最常见的原发性颅内肿瘤,约占所有颅内肿瘤的45%,其中以星形细胞瘤最多见。后者根据恶性程度由低到高分为4个不同级别,分化良好的星形细胞瘤(W


昨日,著名作家李敖先生不幸因病撒手人寰。台北“荣总”医院代家属发出说明稿表示,李敖于2015年7月因步态不稳至医院求诊,经诊断为脑干肿瘤,在医疗团队的努力下,接连度过难关。

根据李敖先生身前的采访以及家属声明,可以得知李敖先生所患的疾病为脑干胶质瘤。

其实胶质瘤是最常见的原发性颅内肿瘤,约占所有颅内肿瘤的45%,其中以星形细胞瘤最多见。后者根据恶性程度由低到高分为4个不同级别,分化良好的星形细胞瘤(WHO I级)生长缓慢,预后良好;胶质母细胞瘤(WHO IV级)恶性程度最高,进展迅速,预后极差。年龄分布上,男性略多于女性;发生部位上,成人多见于大脑半球,而儿童以小脑和脑干较为多见。

脑肿瘤的发生及发展是一个十分复杂的问题,至今尚无定论。现在普遍认为,绝大多数肿瘤是由内在因素与外在因素相互作用引起的。

现明确的致病因素包括长期染发、电离辐射等,其他如电磁场、手机产生的无线电波、外伤、被动吸烟、寄生虫感染、病毒、腌制食品中的亚硝基化合物等均为可能因素。理论上来讲,肿瘤的发生是由于正常细胞的染色体受到遗传及外界因素的影响,发生二次基因突变而形成的。

胶质瘤早期常隐匿起病,根据肿瘤侵犯部位及大小的不同,临床症状表现多样。有些以情感异常和痴呆为主的精神症状;有些以头痛,恶心呕吐为主的颅高压症状;有些以吞咽困难,面瘫,眼睑下垂等为主的神经核团及颅神经体征;有些以偏瘫,偏身感觉障碍及走路不稳等为表现;有些以肢体抽搐(癫痫)起病。

依据CT、MRI、DSA、PET等检查,定位及定性诊断不太困难。目前其标准治疗方案包括:最大程度地安全切除肿瘤,随后接受替莫唑胺(TMZ)同步放化疗及后续的TMZ辅助化疗。

对于低级别肿瘤手术后辅以放疗,预后良好,尤其是WHO I级的毛细胞型星形细胞瘤10年生存率达到90%以上,甚至部分患者得以治愈。恶性度最高的多形性胶质母细胞瘤约占所有胶质瘤的50%,其中位生存期仅15个月,2年生存率不足30%。

脑干胶质瘤预后普遍较差,其生存期明显低于中枢神经系统其他部位肿瘤,特别是儿童型,有研究报导其中位生存期不足7个月。肿瘤一旦复发则预后不良,约50%的肿瘤复发后恶性进展,近1/3肿瘤复发后演变为胶质母细胞瘤,复发后肿瘤的快速生长是常见的死亡原因。

临床上手术有效切除程度与术后生存期成正相关,目前借助术前多模态影像融合技术,术中荧光显像技术、术中磁共振、电生理监测、神经内镜及神经导航等新技术,可以在精确定位下实施微创手术,包括脑干内局限生长的胶质瘤,从而提高肿瘤的切除率,同时神经功能得以有效保全。脑胶质瘤术后常伴有偏瘫、失语、癫痫、脑积水等神经功能障碍,定期MRI随访尤为必要。

近年来一些创新的治疗技术如免疫治疗、分子靶向治疗正在胶质瘤的治疗中扮演着愈来愈重要的作用。总的来说,胶质瘤在脑肿瘤中最为常见,多呈恶性,具有难治性,易局部播撒和复发等特点,尤其是弥散型脑干胶质瘤,无论从临床还是基础都是神经外科的一个挑战。

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    2018-03-26 阿杜12138

    我日.染发致脑癌?

    0

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    2018-03-20 一个字-牛

    学习了涨知识

    0

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    2018-03-20 神功盖世

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    2018-03-20 sunfeifeiyang

    0

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    2018-03-19 清风拂面

    谢谢分享学习

    0

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    2018-03-19 183****7028

    学习

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    2018-03-19 神功盖世

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