5-氨基乙酰丙酸荧光引导显微手术切除人脑胶质瘤的组织病理学研究  

The histopathological study of fluorescence-guided microsurgical human glioma resection after administration of 5-aminolevulinic acid

作　　者：陈广宁[1] 滕雷[1] 李一[1] 单强[1] 鞠东辉[1] 汪立刚[1] 于洪伟[1] 韩大勇[1] 赵世光[1] 

机构地区：[1]黑龙江省齐齐哈尔市第一医院神经外科,哈尔滨医科大学附属第一临床医学院神经外科,161000

出　　处：《齐齐哈尔医学院学报》2008年第7期769-772,F0004,共5页Journal of Qiqihar Medical University

摘　　要：目的探讨荧光引导切除人脑胶质瘤,肿瘤组织荧光特性与组织病理学特性的关系。方法对手术治疗的原发、复发恶性胶质瘤患者在手术中行5-ALA荧光引导下的肿瘤切除。术中使用荧光显微镜检测肿瘤荧光,荧光组织在安全许可的范围内被切除。术中取肿瘤组织的中心,周边和边缘位置的组织,行HE染色作组织病理学分析,比较各部位的组织学特点。利用免疫组化方法检测VEGF,CD31在不同荧光区域组织中的表达。计算并比较不同荧光部位组织的VEGF,CD31的阳性表达。结果在肿瘤的中心部位,荧光显示为鲜红色,肿瘤细胞密度高,肿瘤生长呈共生性,可见血管内皮细胞增生,局部区域有坏死,周边部弱红色的区域肿瘤密度低,肿瘤细胞多呈浸润性生长,少见血管内皮细胞增生。在边缘不发光区域观察到为正常脑组织。免疫组化结果提示VEGF,CD31的表达随荧光强度的降低呈下降趋势。结论荧光手术边界和病理学边界相符;组织的增殖活性以及血管生成特性与荧光强度呈正相关。Objective To study the relationship among different human glioma tissue fluorescence characters and histopathological features.Methods Eight consecutive patients with malignant glioma received doses of 5-ALA（20mg/kg）3 hours before induction of anesthesia.Intraoperatively tumor fluorescence was visualized by usingfluorescein surgical microscope.Fluorescing tissue was removed,whenever it was considered safely possible.To analyze the histological character,operative findings were compared with histological findings from different areas of tumor.The expression of VEGF,CD31 in different areas of tumor was examined by immunohistochemistry andthe positive rate of CD31 and VEGF were calculated.Results A valid solid red fluorescence impression was given by viable,that is,perfused,tumor regions,whereas normal brain tissue was not stained.Our histological findings revealed a large number of tumor cells and a conspicuous vascular reaction such as proliferation of endothelial cells in the fluorescein-positive area.On the other hand,the fluorescein-negative area showed necrosis,or only a small number of tumor cells;little vascular reaction was found there.The expression level of VEGF,CD31 shows increasing tendency with differential intensity of fluorescence increasing.Conclusions There is a consistency between the fluorescence margin and the histological margin.The proliferation activity and angiogenesis shows positive correlations with the fluorescence intensity degree.

关 键 词：5-氨基乙酰丙酸 荧光引导显微切除 恶性胶质瘤 免疫组化 

分 类 号：R739.5[医药卫生—肿瘤] R739.45[医药卫生—临床医学]