功能磁共振联合荧光素钠引导运动区胶质瘤切除的应用  

Application of f MRI combined with fluorescein sodium in the excision of glioma in motor function area

作　　者：郑皓文 张苓 都荣霞 张海旺 彭里磊 陆笑非[3] 刘洛同 明扬 陈礼刚 

机构地区：[1]西南医科大学附属医院神经外科,泸州646000 [2]西南医科大学附属医院泸州市人民医院输血科,泸州646000 [3]西南医科大学附属医院影像科,泸州646000

出　　处：《重庆医科大学学报》2016年第8期859-863,共5页Journal of Chongqing Medical University

基　　金：四川省科技厅资助项目(编号:2013SZZ002;LZ-LY-9);泸州市科技局重点资助项目(编号:12029)

摘　　要：目的:探讨功能磁共振成像(functional magnetic resonance imaging,f MRI)联合荧光素钠(fluorescein sodium,FLS)引导运动区胶质瘤手术治疗的临床应用价值。方法:将我院收治的45例运动区胶质瘤患者随机分组手术治疗。试验组(联合手术组,23例)术前行头颅f MRI检查,术中联合使用FLS治疗;对照组(传统手术组:22例)术前行头颅MRI辅查。术后3 d所有患者行MRI评估肿瘤全切率,术后2周使用Karnofsky评分评价患者术后生存质量。治疗结束后随访2年。观察两组患者在肿瘤切除程度、生存质量及术后2年生存率是否有统计学差别。结果:术后试验组患者中,肿瘤全切除比例为87%,而对照组仅为59.1%。试验组术后2周生存质量分级比例分别为非依赖级为91.3%、半依赖级为8.7%,无依赖级患者;对照组中非依赖级患者比例为45.5%、半依赖级为45.5%和依赖级为9%。实验组术后2年生存率为78.3%,对照组生存率为50%。试验组在肿瘤的全切率(P=0.037)、患者术后2周生存质量(P=0.001)和术后2年生存率(P=0.042)均高于传统手术组。结论:在运动区胶质瘤的手术治疗中,f MRI联合FLS能指导尽可能全切肿瘤组织,保护功能敏感区,显著提高患者生存质量,延长患者术后生存时间。Objective：To investigate the clinical application of functional magnetic resonance imaging（f MRI）combined with fluorescein sodium（FLS）in the excision of gliomas located in motor function area. Methods：Forty-five patients diagnosed as gliomas in or near the motor function area were admitted in our hospital for surgery,and were randomly divided into experimental group（combined surgery group,23 cases） and control group（traditional surgery group,22 cases）. The patients in experimental group received f MRI before surgery,and FLS was used during the operation. The patients in control group received MRI before operation. After the operation,MRI were performed on 3rd day to evaluate the total resection rate of tumor,and Karnofsky score was used to evaluate the patients＇ quality of life. All patients were followed up for two years after surgery,and two-year survival rate was counted. Results：After the operation,the total tumor resection rate was 87% in experimental group and 59.1% in control group. At postoperative 2 weeks,in experimental group,proportion of independent patients,semi-dependent patients and dependent patient was 91.3%,8.7%,0.0%respectively,as compared with 45.5%,45.5%,9% in control group. The 2-year survival was 78.3% in experimental group and 50% in control group. The total resection rate of gliomas（P=0.037）,the quality of life at 2 weeks after surgery（P=0.001）and 2-year survival rate（P=0.042）were significantly higher in experimental group than in control group. Conclusion：In the resection of gliomas in or near the motor function area,f MRI combined with FLS can improve the degree of tumor resection,protect the motor function area,and significantly improve the quality of life and prolong the survival of patients.

关 键 词：运动区 胶质瘤 荧光素钠 功能磁共振 传统手术 

分 类 号：R730.264[医药卫生—肿瘤] R730.56[医药卫生—临床医学]