术中超声联合荧光素钠在高级别胶质瘤显微手术中的应用  

Application of Intraoperative Ultrasound Combined with Sodium Fluorescein in Microsurgery of High Grade Glioma

作　　者：曹红磊 刘飞皎[1] 孙含蓄[1] 张峰[2] CAO Honglei;LIU Feijiao;SUN Hanxu(Nanyang First People's Hospital,Nanyang,473000)

机构地区：[1]河南省南阳市第一人民医院,473000 [2]南阳医学高等专科学校,473000

出　　处：《实用癌症杂志》2022年第9期1454-1457,共4页The Practical Journal of Cancer

摘　　要：目的探讨术中超声联合荧光素钠实时显像方法在高级别胶质瘤显微手术切除中的应用价值。方法选取28例(观察组)高级别胶质瘤患者,进行荧光素钠染色,根据肿瘤染色后的强弱结合术中超声确定肿瘤边界进行显微切除。选取(对照组)既往28例高级别胶质瘤按照传统方法行显微手术切除的患者,评估2组手术效果。结果术后复查增强MRI对比术中超声定位准确,显微镜下可见肿瘤能够被荧光素钠染成深染区(黄绿色)、淡染区(淡黄色)及无染色区,恶性程度越高染色越深,患者术中、术后均无荧光素钠过敏及不适反应。观察组患者肿瘤全切率(92.86%)显著高于对照组(71.43%);手术时间及术后住院时间明显少于对照组。观察组患者术后肌力下降4例,明显低于对照组(10例);术后生存质量评分(KPS评分)优于对照组。术后随访6个月,肿瘤复发率观察组低于对照组。以上指标差异均具有统计学意义(P<0.05)。结论术中超声联合荧光素纳应用于术中可以在术中准确确定肿瘤边界,达到最大限度切除肿瘤,保护正常脑组织,降低术后复发率,延迟术后复发时间,提高患者术后生存质量。Objective To explore the value of intraoperative ultrasound combined with real-time imaging of fluorescein sodium in microsurgical resection of high-grade glioma.Methods 28 cases(observation group)of high-grade glioma received sodium flourescein staining,according to the strength of the tumor,these patients underwerwent the intraoperative ultrasound combined with sodium fluorescein staining to determine the tumor boundary and guided microdissection.28 patients with high-grade glioma(control group)underwent the traditional surgery.The surgical results between the 2 groups were compared.Results Postoperative review of enhanced MRI showed that intraoperative ultrasound localization was accurate.Under the operating microscope,the tumor can be stained by luciferin sodium into dark(yellowish green),light(yellowish yellow),and non-stained areas.The more malignant the tumor,the darker the stain.There was no allergic reaction or discomfort to fluorescein sodium during and after operation.The total tumor resection rate of the observation group(92.86%)was significantly higher than that of the control group(71.43%).The operation time and postoperative hospital stay were significantly less than the control group.In the observation group,muscle strength decreased in 4 cases,significantly lower than that in the control group(10 cases).Postoperative quality of life score(KPS score)was better than the control group.After 6 months of follow-up,the tumor recurrence rate in the observation group was lower than that in the control group,and the difference in the above indicators was statistically significant(P<0.05).Conclusion Intraoperative ultrasound combined with fluorescein sodium can accurately determine the tumor boundary during surgery,maximize tumor resection,protect normal brain tissue,reduce postoperative recurrence rate,delay postoperative recurrence time,and improve postoperative quality of life.

关 键 词：术中超声 荧光素钠 高级别胶质瘤 显微手术 

分 类 号：R739.41[医药卫生—肿瘤]