磁共振波谱联合荧光素钠导航显微手术切除幕上高级别胶质瘤的随访结果和临床意义  

Follow-up Results and Clinical Significance of Magnetic Resonance Spectroscopy Combined with Fluorescence Microscopy in Resection of High Grade Supra-tentoria Gliomas

作　　者：田海龙[1] 祖玉良 何伟[1] 张宁宁 王益华[1] 郭振涛[1] 王超超[1] 姜彬[1] 殷鑫[1] 王志刚[1] 

机构地区：[1]山东大学齐鲁医院神经外科,山东青岛266000

出　　处：《中国医学科学院学报》2017年第5期646-651,共6页Acta Academiae Medicinae Sinicae

基　　金：青岛市科技惠民专项计划(17-3-3-36-nsh);山东大学齐鲁医院(青岛)科研启动基金(QDKY2015LH01;QDKY2016QN08)~~

摘　　要：目的评估磁共振波谱分析(MRS)结合荧光素钠(FL)导航切除位于幕上的高级别胶质瘤(HGG)的临床效果。方法回顾性分析2013年8月至2015年11月在山东大学齐鲁医院经手术病理确诊的72例幕上HGG(WHOⅢ~Ⅳ级)患者的临床资料,分为MRS联合术中FL导航组(观察组,n=43)和显微外科手术组(对照组,n=29)两组。所有患者术前及术后第24~48 h均行MRI增强检查,比较两组患者的肿瘤切除程度。术后均行同步放化疗,采用Karnofsky(KPS)评分评价患者术后6个月的生存质量,观察患者术后1年的生存率和肿瘤无进展生存时间(PFS)。结果观察组患者的肿瘤完全切除(GTR)率显著高于对照组(72.09%比51.72%;χ~2=23.88,P=0.001),观察组中WHOⅣ级患者的肿瘤GTR率显著高于WHOⅢ级(92.86%比62.07%;χ~2=6.06,P=0.042)。观察组术后6个月的KPS评分显著高于对照组(μ=2.34,P=0.021)。平均随访(16.4±2.4)个月(8~21个月),观察组和对照组患者的1年生存率(74.07%比77.50%;χ2=4.90,P=0.165)和PFS[(13.2±1.2)个月比(12.7±2.0)个月;χ~2=7.26,P=0.067]差异均无统计学意义。两组中WHOⅣ级患者的1年生存率(71.43%比72.54%;χ~2=5.33,P=0.089)差异无统计学意义;观察组WHOⅣ级患者的PFS明显高于对照组[(14.2±0.3)个月比(10.0±1.1)个月;χ~2=11.03,P=0.031]。两组中WHOⅢ级患者的1年生存率(75.86%比72.22%;χ~2=3.78,P=0.250)和PFS[(13.7±1.4)个月比(12.4±0.8)个月;χ~2=4.85,P=0.083]差异均无统计学意义。结论 MRS联合术中FL导航技术能在保护神经功能前提下提高幕上HGG切除率,改善患者生存质量,目前没有发现延长肿瘤生存期的证据,但随样本量和随访时间增加,可能会观察到不同的预后指标。Objective To investigate the clinical effectiveness of magnetic resonance spectroscopy( MRS) combined with sodium fluorescein( FL) in the treatment of high grade gliomas( HGG). Methods From August 2013 to 2015 November,the clinical data of 72 supratentorial HGG( WHO grade Ⅲ-Ⅳ) patients who had received surgical treatment in our hospital were retrospectively studied,among whom 43 cases received MRS combined with intra-perative FL navigation( observation group),and 29 cases only received conventional surgery( control group). Post-operative radiotherapy and chemotherapy were applied for more than 3 months.Routine enhanced MRI were performed 24-48 hours after the operation to investigate the extent of tumor resection.Six months after the operation,the quality of life of patients was evaluated by using the Karnofsky score,and 1-year postoperative survival rate and progression-free survival( PFS) were observed. Results Postoperative MRI showed that the rate of gross total resection( GTR) in observation group was significantly higher than that in control group( 72. 09% vs. 51. 72%; χ2= 23. 88,P = 0. 001),and the GTR rate of WHO grade Ⅳ tumors was significantly higher than that of WHO grade Ⅲ tumors in observation group( 92. 86% vs. 62. 07%; χ2= 6. 06,P = 0. 042). The postoperative Karnofsky score in the observation group was significantly higher than that in control group( μ = 2. 34,P = 0. 021). The mean time of follow-up was( 16. 4 ± 2. 4) months( 8-21 months)and there was no statistical significant difference between observation group and control group in 1-year survival rate( 74. 07% vs. 77. 50%; χ2= 4. 90, P = 0. 165) and PFS [( 13. 2 ± 1. 2) months vs.( 12. 7 ± 2. 0)months; χ2= 7. 26,P = 0. 067]. In observation group,the PFS of WHO grade Ⅳ patients was significantly higher than that in control group [( 14. 2 ± 0. 3) months vs.( 10. 0 ± 1. 1) months; χ2= 11. 03,P = 0. 031].There was also no statistical significant difference between WHO grade Ⅳ tumors in two groups in terms of 1-year survival

关 键 词：高级别胶质瘤 磁共振波谱 荧光素钠 随访 

分 类 号：R616.2[医药卫生—外科学]