术中超声在脑功能区胶质瘤切除术中的应用价值  

Application value of intraoperative ultrasound in the resection of glioma located in functional cerebral areas

作　　者：蒋克 郑夏林[1] 苏贺先[1] 李健[1] 徐德才[1] Jiang Ke;Zheng Xialin;Su Hexian;Li Jian;Xu Decai(Department of Neurosurgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]蚌埠医学院第一附属医院神经外科,安徽省蚌埠市233004

出　　处：《中华解剖与临床杂志》2021年第5期565-570,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨术中超声(IOUS)在切除脑功能区胶质瘤中的临床价值。方法回顾性队列研究。纳入2018年12月—2020年6月蚌埠医学院第一附属医院神经外科62例脑功能区胶质瘤患者,其中男26例、女36例,年龄28~68岁;胶质瘤WHO分级Ⅰ级13例、Ⅱ级22例、Ⅲ级21例、Ⅳ级6例。62例患者均行肿瘤开颅显微切除术,根据是否应用IOUS分为两组:应用IOUS者31例纳入观察组,未应用IOUS者31例纳入对照组。比较两组患者临床基线资料;对比观察低级别(Ⅰ~Ⅱ级)与高级别(Ⅲ~Ⅳ级)脑胶质瘤患者的IOUS声像图表现;对术中暴露肿瘤时间、手术时间、肿瘤的切除程度、术后第5天患者脑水肿程度等围术期指标观察结果进行组间比较,并依据卡氏评分(KPS)评价两组患者术后3个月神经功能恢复情况。结果两组患者性别、年龄,肿瘤的大小、位置、级别,肿瘤中心至硬脑膜的垂直距离,术前患者脑水肿程度和神经功能KPS评分等基线资料比较,差异均无统计学意义(P值均>0.05)。观察组暴露肿瘤时间(23.1±3.7)min短于对照组的(37.3±4.3)min,肿瘤切除程度高于对照组,术后第5天脑水肿程度较对照组轻,术后3个月KPS(78.32±4.32)分高于对照组术后3个月KPS(74.22±2.38)分,组间差异均有统计学意义(P值均<0.05);观察组与对照组手术时间分别为(187.4±17.8)min和(194.8±15.8)min,组间比较差异无统计学意义(P>0.05)。低级别和高级别胶质瘤IOUS回声均较脑组织回声高,但前者边缘规整、内部较均匀并可见钙化的强回声,而后者边缘为模糊的的混合回声影、内部呈不均匀回声或无回声的坏死囊变区。结论不同级别脑胶质瘤的IOUS声像图表现不同。IOUS应用于功能区胶质瘤开颅显微手术中,具有实时定位准确的优点,可提高肿瘤全切率,减轻术后脑水肿,保护及改善术后神经功能。Objective To explore the clinical value of intraoperative ultrasound(IOUS)in the removal of gliomas in the functional areas of the brain.Methods A retrospective cohort study was conducted on 62 patients with gliomas in functional brain areas who were admitted to the Department of Neurosurgery of the First Affiliated Hospital of Bengbu Medical College from December 2018 to June 2020.The patients included 26 males and 36 females aged 28-68 years.Among the patients,13 cases had grade I glioma,22 cases had gradeⅡglioma,21 cases had gradeⅢglioma,and 6 cases had gradeⅣglioma based on WHO classification.All patients underwent tumor craniotomy and were divided into two groups according to whether or not ultrasound was used during operation.Thirty-one cases who used IOUS were included in the observation group,and 31 cases who did not use IOUS were included in the control group.The following clinical baseline data of the two groups of patients were compared:the sonographic performance of IOUS on different grades of glioma,the time taken to expose the tumor during the operation,the duration of the operation,the degree of tumor resection,and the degree of brain edema on the 5th day after the operation.Karnofsky performance status(KPS)score was used to evaluate the recovery of neurological function in the two groups at 3 months after surgery.Results The two groups had no statistically significant differences in gender,age,tumor size,tumor location,tumor grade,the vertical distance from the tumor center to the dura mater,the degree of brain edema,and neurological KPS before operation(all P values>0.05).Different grades of glioma had different sonogram features.The IOUS echo of low-grade glioma a higher than that of brain tissue,the interior was slightly uniform with regular edges,and strong echoes with calcification could be observed inside.High-grade glioma had better IOUS echo than the brain,and the edges were blurred,mixed echo shadows were present,and the necrotic cystic area had non-uniform internal echo or was non-

关 键 词：神经胶质瘤 术中超声 大脑功能区 神经外科 神经系统疾病 

分 类 号：R739.41[医药卫生—肿瘤]