磁共振引导激光间质热疗治疗脑转移瘤的疗效分析  

Efficacy analysis of magnetic resonance-guided laser interstitial thermal therapy for the treatment of brain metastases

作　　者：管修东 薛湛[1] 马顺昌 原林皓 康鹏[1] 贾旺[1,2] Guan Xiudong;Xue Zhan;Ma Shunchang;Yuan Linhao;Kang Peng;Jia Wang(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100070 [2]首都医科大学,北京市神经外科研究所,100070

出　　处：《中华神经外科杂志》2021年第8期757-763,共7页Chinese Journal of Neurosurgery

基　　金：首都卫生发展科研专项(首发2018-1-1071)。

摘　　要：目的初步探讨磁共振引导激光间质热疗对脑转移瘤患者的临床治疗效果。方法回顾性分析2021年1—6月首都医科大学附属北京天坛医院神经外科收治的5例行磁共振引导激光间质热疗治疗的脑转移瘤患者的临床资料。5例患者的年龄为42~80岁;原发灶包括乳腺癌2例、肺癌2例、结肠癌1例。术前均经多学科评估。术后评价标准包括肿瘤消融率、1个月后的病灶消融状态;临床随访结果采用Karnofsky功能状态评分(KPS)评估;影像学随访观察肿瘤的进展情况。结果5例脑转瘤患者中,3例单发病灶采用单激光套管消融治疗,1例双发病灶同期分别采用单激光套管消融治疗,1例单发病灶采用双激光套管消融治疗。6个消融病灶的术前肿瘤体积为746.0~11732.3 mm^(3)。激光发射时长为221~1552 s,消融时长为602~4444 s。实际消融体积为2092.8~8000.0 mm^(3)。术后头颅MRI复查显示,肿瘤消融率为68.2%~100.0%。1例患者术后肢体肌力进一步下降,余4例患者无新增并发症;5例患者的KPS为60~90分。激光消融术后患者的住院时长为3~7 d。5例患者的随访时间为1~3个月,MRI复查显示4例肿瘤无进展,1例残余病灶稳定。结论初步结果提示,磁共振引导激光间质热疗对单发、散发脑转移瘤的治疗安全、有效,为高龄、肿瘤位置深在或不能耐受常规手术治疗的脑转移瘤患者提供了新的治疗选择。Objective To preliminarily explore the clinical effect of magnetic resonance-guided laser interstitial thermal therapy(MRgLITT)on patients with brain metastases.Methods A retrospective analysis was conducted on the clinical data of 5 patients with brain metastases who underwent MRgLITT at the Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from January to June 2021.The ages of the 5 patients ranged from 42 to 80 years.Among those 5 patients,2 cases were breast cancer brain metastases,2 cases were lung cancer brain metastases,and 1 case was colon cancer brain metastasis.All patients underwent multi-disciplinary presurgical evaluations.Postoperative evaluation criteria included tumor ablation rate and lesion ablation status one month later.Clinical follow-up results were evaluated by Karnofsky functional status score(KPS).Imaging follow-up was performed to observe tumor progression.Results Among the 5 patients with metastatic brain tumors,3 cases of single lesion were treated with single cannula laser ablation,1 case with double lesions was treated with two procedures of single cannula laser ablation at the same time,and 1 case with single lesion was treated with double cannula laser ablation.The preoperative tumor volume of the 6 lesions ranged from 746.0 to 11732.3 mm^(3).The duration of laser emission was 221-1552 s,and the duration of ablation was 602-4444 s.The actual ablation volume was 2092.8-8000.0 mm^(3).Postoperative head MRI reexamination showed that the tumor ablation rate was 68.2%-100.0%.The muscle strength of the limbs of 1 patient further decreased after the operation,and the remaining 4 patients had no new complications.The KPS of 5 patients was 60-90 points.The length of hospital stay for patients after laser ablation was 3 to 7 days.The follow-up time of 5 patients was 1 to 3 months.MRI re-examination showed that 4 cases had no tumor progression,and 1 case had stable residual lesions.Conclusion The preliminary results suggest that MRgLITT is safe and effective for t

关 键 词：脑肿瘤 脑转移 磁共振成像 激光间质热疗 治疗结果 

分 类 号：R739.41[医药卫生—肿瘤]