神经导航联合黄荧光染色技术在小脑幕上胶质瘤切除中的作用  

Application of neuronavigation combined with yellow fluorescence staining in the resection of supratentorial glioma

作　　者：杨福刚 赵宇航[1] 黄文宏 杨超 马超[1] 徐成仕[1] 李志强[1] Yang Fugang;Zhao Yuhang;Huang Wenhong;Yang Chao;Ma Chao;Xu Chengshi;Li Zhiqiang(Department of Neurosurgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院神经外科,430071

出　　处：《中华神经外科杂志》2020年第3期253-257,共5页Chinese Journal of Neurosurgery

基　　金：国家卫健委医药卫生科技发展研究中心"重大疾病防治科技行动计划"(2018ZX-07S-011)。

摘　　要：目的探讨神经导航联合黄荧光染色技术在小脑幕上胶质瘤手术中的作用。方法回顾性分析2016年1月至2018年3月于武汉大学中南医院神经外科行手术治疗的172例小脑幕上胶质瘤患者的临床资料。其中55例采用神经导航联合黄荧光染色技术(简称导航+荧光组),117例采用常规手术技术(常规手术组)。81例患者的肿瘤位于功能区,术中均使用神经电生理监测和(或)术中唤醒麻醉技术。对比两组患者的肿瘤全切除率,进一步采用单因素和多因素logistic回归分析影响肿瘤全切除率的相关因素。结果172例患者中,肿瘤全切除者58例(33.7%),其中导航+荧光组的肿瘤全切除率为45.5%(25/55),常规手术组为28.2%(33/117),两组比较差异有统计学意义(P=0.026)。多因素logistic回归分析结果显示,功能区肿瘤(OR=0.502,95%CI:0.253~0.998,P=0.049)、术中应用导航+荧光(OR=2.173,95%CI:1.080~4.371,P=0.030)是影响肿瘤全切除的独立因素。81例功能区肿瘤患者中,肿瘤全切除者21例(25.9%),其中13例(61.9%)术中应用导航+荧光;60例非全切除者中,16例(26.7%)术中应用导航+荧光;两组比较差异有统计学意义(P=0.004)。多因素logistic回归分析显示,术中应用导航+荧光是影响功能区肿瘤全切除的独立因素(OR=3.896,95%CI:1.331~11.405,P=0.013)。结论神经导航联合术中黄荧光染色技术有利于提高脑胶质瘤的切除程度。Objective To explore the application of neuronavigation combined with yellow fluorescence staining in the operation of glioma.Methods A retrospective study was conducted on the clinical data of 172 patients with supratentorial glioma who underwent surgical treatment at Department of Neurosurgery,Zhongnan Hospital of Wuhan University from January 2016 to March 2018.Among them,55 cases were treated with neuronavigation combined with yellow fluorescence staining(navigation+fluorescence group)and 117 cases with conventional surgical techniques(control group).There were 81 patients with tumors involving the eloquent area,and neuroelectrophysiological monitoring and/or intraoperative awake anesthesia were applied in all those patients.Total resection rate was compared between the 2 groups to analyze the factors influencing the total resection rate.Results Total resection was performed in 58 patients confirmed by postoperative imaging.The total resection rate was 45.5%(25/55)in group of neuronavigation+fluorescence and 28.2%(33/117)in the control group.There was statistically significant difference between the 2 groups(P=0.026).Multiple logistic regression analysis revealed that involvement of eloquent area(OR=0.502,95%CI:0.253-0.998,P=0.049)and the technique of neuronavigation plus fluorescence(OR=2.173,95%CI:1.080-4.371,P=0.030)were independent prognostic factors of the total resection for glioma.Among the 81 patients involving the eloquent area,total resection was achieved in 21 patients(25.9%),of whom 13(61.9%)were treated with fluorescence combined with neuronavigation.Incomplete resection was achieved in 60 patients,of whom 16(26.7%)were treated with fluorescence combined with neuronavigation.There was statistically significant difference between the 2 groups(P=0.004).Multiple logistic regression analysis revealed that the technique of neuronavigation combined with fluorescence(OR=3.896,95%CI:1.331-11.405,P=0.013)were independent prognostic factors of total resection.Conclusion Neuronavigation combined with yellow

关 键 词：神经胶质瘤 神经导航 荧光染色 神经外科手术 切除程度 

分 类 号：R73[医药卫生—肿瘤]