术中高场强MRI联合荧光引导技术在脑胶质瘤切除术中的应用  

Resection of gliomas by intraoperative high-field MRI combined with fluorescence-guided

作　　者：董泽平 赵旸 陈凡[1] 李文忠[1] 陈大伟[1] DONG Ze-ping;ZHAO Yang;CHEN Fan;LI Wen-zhong;CHEN Da-wei(Department of Neurosurgery,The First Bethune Hospital of Jilin University,Changchun 130021,Jilin,China)

机构地区：[1]吉林大学白求恩第一医院神经肿瘤外科,长春130021

出　　处：《中国现代神经疾病杂志》2021年第11期988-993,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：吉林省教育厅“十三五”科学技术项目(项目编号:JJKH20190039KJ)。

摘　　要：目的探讨术中高场强MRI联合荧光引导下脑胶质瘤切除术的有效性和安全性。方法纳入吉林大学白求恩第一医院2017年6月至2018年6月收治的53例脑胶质瘤患者,其中33例(62.26%)肿瘤位于重要脑功能区(运动区17例,语言区11例,丘脑5例),分别行荧光引导下脑胶质瘤切除术(荧光引导组,28例)和术中高场强MRI联合荧光引导下脑胶质瘤切除术(联合组,25例)。结果本组53例患者肿瘤全切除42例(79.25%),次全切除11例(20.75%);33例肿瘤位于重要脑功能区患者,肿瘤全切除25例(75.76%),次全切除8例(24.24%);经术后病理证实星形细胞瘤(WHOⅡ级)12例(22.64%),间变性星形细胞瘤(WHOⅢ级)17例(32.08%),胶质母细胞瘤(WHOⅣ级)24例(45.28%);术后出现言语障碍16例(30.19%)、短暂性肢体活动障碍21例(39.62%)、精神障碍6例(11.32%)、颅内感染8例(15.09%)、少量硬膜外出血2例(3.77%),无死亡病例。联合组手术时间长于荧光引导组[(3.79±1.14)h对(2.53±1.04)h;t=-4.718,P=0.000],肿瘤全切除率高于荧光引导组[92%(23/25)对67.86%(19/28);χ^(2)=4.681,P=0.031],WHO分级比例组间差异具有统计学意义(χ^(2)=2.041,P=0.036),而重要脑功能区肿瘤全切除率[88.89%(16/18)对60%(9/15);Fisher确切概率法:P=0.101]和术后并发症发生率[37.73%(20/53)对62.26%(33/53);χ^(2)=0.179,P=1.000]组间差异无统计学意义。术后平均随访9个月,肿瘤复发11例(20.75%),联合组与荧光引导组肿瘤复发率差异无统计学意义[12%(3/25)对28.57%(8/28);χ^(2)=2.205,P=0.138]。结论术中高场强MRI联合荧光引导技术可以显著提高脑胶质瘤全切除率,同时尽可能保留重要脑功能区和神经结构,提高患者生活质量和延长无进展生存期。Objective To investigate the efficacy and safety of intraoperative high-field MRI combined with fluorescence-guided glioma resection. Methods A total of 53 patients with glioma admitted to The Fisrt Bethune Hospital of Jilin University from June 2017 to June 2018 were enrolled, including 33 patients (62.26%) whose tumors were located in important brain functional areas (17 cases in motor area, 11 cases in language area, 5 cases in thalamus). Glioma resection was performed under fluorescence-guided (fluorescence guidance group, n=28) and intraoperative high-field MRI combined with fluorescence-guided glioma resection (combined group, n=25). Results Total tumor resection was performed in 42 cases (79.25%) and subtotal tumor resection in 11 cases (20.75%). Of the 33 patients whose tumors were located in important brain functional areas, total resection was performed in 25 cases (75.76%) and subtotal resection in 8 cases (24.24%). There were 12 cases (22.64%) of astrocytoma (WHO grade Ⅱ), 17 cases (32.08%) of anaplastic astrocytoma (WHO grade Ⅲ) and 24 cases (45.28%) of glioblastoma (WHO grade Ⅳ) were confirmed by postoperative pathology. There were 16 cases of speech disorder (30.19%), 21 cases of transient limb movement disorder (39.62%), 6 cases of mental disorder (11.32%), 8 cases of intracranial infection (15.09%), 2 cases of small epidural hemorrhage (3.77%), and no death after the operation. The operation time of combined group was longer than that of fluorescence guidance group[(3.79±1.14) h vs. (2.53±1.04) h;t=-4.718, P=0.000]. The tumor total resection rate in the combined group was higher than that in fluorescent guidance group[92% (23/25) vs. 67.86% (19/28);χ^(2)=4.681, P=0.031], the WHO grade had significant difference between 2 groups (χ^(2)=2.041, P=0.036), but the tumor total resection rate in important brain functional areas[88.89% (16/18) vs. 60% (9/15);Fisher's exact probability:P=0.101] and the incidence of postoperative complications[37.73% (20/53) vs. 62.26% (33/53);χ^(2)=0.179, P=1.0

关 键 词：神经胶质瘤 磁共振成像 荧光素 神经外科手术 

分 类 号：R739.41[医药卫生—肿瘤] R445.2[医药卫生—临床医学]