摘要： 研究背景  复发恶性胶质瘤由于肿瘤浸润而侵犯重要神经或脑深层结构，进一步增加再次手术和治疗的难度。因此，如何制定合理的治疗策略，在最大限度切除肿瘤的同时保证患者基本生存质量，是目前争论的热点。本文旨在探讨复发恶性胶质瘤的合理治疗方式和最佳手术策略。方法  对4 例典型复发恶性胶质瘤患者术前影像、术中操作、术后并发症，以及远期随访结果进行综合评价，阐述对其治疗策略。结果  其中2 例术后MRI 检查显示复发肿瘤位于T2WI 少量水肿残余部位；1 例根据T2WI 所示于术中行水肿带扩大切除，术后近期出现感觉性失语和右侧肢体乏力，经改善脑循环、高压氧，辅助针灸及物理康复训练症状明显改善；1 例脑干胶质瘤采取激光刀精确“雕刻式”手术切除，术后未出现明显神经功能障碍表现，恢复良好。4 例患者术后均接受替莫唑胺（200 mg/kg，5 d/28 d）化疗，平均随访（14.00 ± 12.50）个月。结论  对于明显复发的恶性胶质瘤患者，再次手术仍是延长生存时间的关键，扩大切除T2WI 所示水肿带能减少肿瘤复发机会。在保持患者术后基本生存质量（Karnofsky 生活质量评分> 70 分）基础上，应采用病灶扩大全切除；而针对毗邻脑功能区的肿瘤病灶，则应采取精确“雕刻式”切除，尽量减少肿瘤细胞残留。

关键词: 神经胶质瘤； 肿瘤复发, 局部； 神经外科手术

Abstract: Objective Recurrent malignant gliomas often violate important neurological function parts or deep brain structures due to tumor invasion, further increasing the difficulty of reoperation and treatment. Therefore, how to develop a reasonable treatment strategy, maximize the removal of the tumor, and ensure a basic quality of life of the patient, is nowadays hotly debated by scholars from various countries. This article aims to explore the reasonable treatment and optimal surgical strategy of recurrent malignant gliomas. Methods Four cases of recurrent malignant glioma were collceted. A comprehensive assessment on preoperative imaging, intraoperative operation, postoperative complications and long-term follow-up was made, and treatment strategy was elaborated. Results Postoperative MRI in 2 cases showed the recurrent tumors located in remnant edema parts, which were revealed by T2WI after first resections. One case underwent expanded resection of edema parts according to T2WI. This patient suffered short-sensory aphasia and weakness of right limbs, but recovered by improving cerebral circulation, hyperbaric oxygen, auxiliary acupuncture and physical rehabilitation trainings. One case with brainstem glioma underwent precise resection by laser knife, without postoperative neurological disorders. All the 4 cases received postoperative chemotherapy with TMZ (200 mg/kg, 5 d/28 d). The average follow-up period was (14.00 ± 12.50) months. Conclusion For obvious recurrence of malignant glioma, reoperation is still the key factor to lengthen the survival of patients, and expanded resection of the edema area supplemented by T2WI can reduce recurrence. Under the precondition of maintaining the basic postoperative quality of life of patients (KPS > 70), expanded resection should be used. As for tumors adjacent to the eloquent areas, precise engraving resection should be used to minimize residual tumor cells．

Key words: Glioma, Neoplasm recurrence, local, Neurosurgical procedures