术中超声引导脑胶质瘤手术对患者生存时间的评价  

Evaluation of intra-operative ultrasonography-guided cerebral glioma surgery on long-term follow-up results of patients

作　　者：王佳[1] 段云友[1] 刘禧[1] 巴咏梅 王樑[2] 袁丽君[1] 曹铁生[1] 

机构地区：[1]第四军医大学唐都医院超声科,西安710038 [2]第四军医大学唐都医院神经外科,西安710038 [3]医院新疆哈密军分区卫生所

出　　处：《中华超声影像学杂志》2013年第11期941-944,共4页Chinese Journal of Ultrasonography

摘　　要：目的探讨术中超声对引导脑胶质瘤手术入路、提高手术全切除率和患者生存时间等方面的应用价值。方法对经CT或MRI疑为脑胶质瘤，术后经病理证实的119例患者，对其生存时间进行定期随访。随机选取未经术中超声引导进行手术的低级别脑胶质瘤和高级别脑胶质瘤患者各30例，随访其生存时间并分别统计分析与本组研究对象的生存率差异。结果119例患者中101例随访资料完整，随访率84．9％，随访时间为6～60个月。根据术后早期复查的影像学结果判断病灶完全切除68例（67．3％），次全切除33例（32．7％）。病例随访中65例出现局部复发，复发率64．4％，其中60例患者在随访过程中因肿瘤复发死亡。低级别脑胶质瘤患者生存率明显高于高级别脑胶质瘤患者。全切除患者的术后生存时间明显长于次全切除患者。低级别脑胶质瘤对照组与高级别脑胶质瘤组分别与研究组术后6个月、1年、2年、4年、5年生存率比较，两组6个月生存率差异无统计学意义（P〉0．05），1年、2年、4年及5年生存率差异具有统计学意义（P〈0．05）。结论超声引导脑胶质瘤切除术可帮助术者明确肿瘤和周围重要结构的关系，达到最大限度切除肿瘤和保护正常脑组织的目的，增加手术的安全性，提高肿瘤的全切率和患者的生存时间。Objective To investigated the value of intraoperative ultrasonography in guiding the surgical approach,improving the total resection rate of the tumor, and the survival time of patients who underwent resection of cerebral gliomas. Methods One hundred and ninteen patients with cerebral gliomas （pathologically confirmed） comprised the study groups. Patients who underwent intraoperative ultrasound- guided surgery were followed up for 6 - 60 months. In addition, randomly selected low and high grade cerebral glioma patients （all 30 cases of which were without intraoperative ultrasonography guidance） served as the control groups. Follow-up included survival time, and the differences in survival time between the study groups and control groups were statistically analyzed. Results Complete follow-up data were obtained for 101 of 119 cases （84.9%） for a follow-up time of 6 60 months. Total removal of the lesion was achieved in 68 cases （67.3%） and subtotal removal in 33 cases （32.7%）. Sixty-five cases had partial recurrence （64. 4%） and 60 patients died due to tumor recurrence. Survival in patients with low-grade gliomas （LGG） was significantly higher than that in patients with high grade gliomas （HGG）. Patients with total tumor resection had a longer survival time than patients who had subtotal tumor resection. In the control LGG group,6-month survival was 96.7 %, 1-year survival was 73.3%, 2-year survival was 53.3 %, 4-year survival was 36.7% and 5-year survival was 26.7%. In the control HGG group, survival at 6 months,1 year, 2 years, 4 year and 5 years was 83.3%,36.7%, 13.3%, 3%, 0 respectively. When comparing survival between the control groups and study groups, there was no significant difference at 6 months （ P 〈 0.05）, but survival at 1 year, 2 years, 4 year and 5 years was different （ P 〈 0. 05）.Conclusions Intraoperative ultrasonography-guided resection of cerebral gliomas helps the surgeon to understand the relationship between the lesion and the surrounding structure

关 键 词：超声检查 神经胶质瘤 存活率 

分 类 号：R739.4[医药卫生—肿瘤]