多模态神经导航联合荧光素钠在颅内高级别胶质瘤手术中的应用效果  

Clinical efficacy of multimodal neuro-navigation combined with intraoperative sodium fluorescein in the treatment of intracranial high-grade gliomas

作　　者：王忠 张晓军 张瑞剑 韩志桐 杨文博 陈云照 邢栋 王俊青 杨蔚然 张之龙 Wang Zhong;Zhang Xiaojun;Zhang Ruijian;Han Zhitong;Yang Wenbo;Chen Yunzhao;Xing Dong;Wang Junqing;Yang Weiran;Zhang Zhilong(Department of Neurosurgery,Inner Mongolia Autonomous Region People′s Hospital,Hohhot 010017,China)

机构地区：[1]内蒙古自治区人民医院神经外科,呼和浩特010017

出　　处：《中华神经外科杂志》2024年第8期815-820,共6页Chinese Journal of Neurosurgery

基　　金：内蒙古自治区卫健委科技计划(202201059);内蒙古自治区人民医院院内基金(2019YN04);内蒙古医科大学联合项目(YKD2023LH082)。

摘　　要：目的探讨多模态神经导航联合术中荧光素钠染色在高级别脑胶质瘤(HGG)手术中的应用效果。方法回顾性分析2018年1月至2021年12月内蒙古自治区人民医院神经外科收治的47例小脑幕上HGG患者(观察组)的临床资料,患者术前均行多模态图像融合并制定术前导航计划,术中应用多模态神经导航和荧光素钠染色辅助切除肿瘤。纳入2012年1月至2017年12月采用传统显微镜直视下切除肿瘤的47例HGG患者为对照组。比较两组的基线资料、肿瘤切除程度、术后新发神经功能障碍、术后肌力和Karnofsky功能状态评分(KPS)较术前的改善情况,以及并发症的发生情况。绘制Kaplan-Meier生存曲线,采用log-rank检验比较两组的生存预后。结果观察组与对照组的性别、年龄、肿瘤部位和侧别、邻近的功能区、肿瘤病理学级别(世界卫生组织级别)以及术前KPS的差异均无统计学意义(均P>0.05)。观察组的肿瘤全切除率、术后肌力改善比例以及术后3个月的KPS均高于对照组,差异均有统计学意义(均P<0.05);而术后出现新发神经功能障碍的比率低于对照组(P<0.05)。两组的住院时长、手术时长、并发症发生率的差异均无统计学意义(均P>0.05)。Log-rank检验结果表明,观察组患者术后6、12、18个月的生存率(分别为87.2%、53.2%、21.3%)均高于对照组(分别为63.8%、27.6%、10.6%)(均P<0.05);无进展生存期[分别为(4.00±1.91)个月和(2.83±1.59)个月]和总生存期[分别为(12.49±5.34)个月和(9.26±5.79)个月]均大于对照组(均P<0.05)。结论与传统显微镜直视下的手术方式相比,多模态功能神经导航联合术中荧光素钠辅助切除HGG的方法全切除率高,并发症少,患者的生存预后较好。Objective To investigate the clinical efficacy of multimodal neuro-navigation combined with intraoperative sodium fluorescein(SFL)in the treatment of intracranial high-grade gliomas(HGG).Methods The clinical data of 47 patients with HGG(observation group)admitted to the Department of Neurosurgery of Inner Mongolia Autonomous Region People′s Hospital from January 2018 to December 2021 were retrospectively analyzed.The patients underwent multimodal image fusion and a preoperative navigation plan was developed before surgery,and multimodal neuronavigation and sodium fluorescein were used to assist in tumor resection during surgery.A total of 47 patients with HGG who underwent tumor resection under microscopy from January 2012 to December 2017 were included as the control group.The baseline data,the degree of tumor resection,the postoperative newly-developed neurological deficits,the improvement of postoperative muscle strength and Karnofsky performance scale(KPS),and the occurrence of complications were compared between the two groups.The Kaplan-Meier survival curve was plotted,and the log-rank test was used to compare the survival of the two groups.Results There were no significant differences in gender,age,tumor location and side,adjacent functional areas,World Health Organization grade of tumor,or preoperative KPS between the observation group and the control group(all P>0.05).The rate of total tumor resection,the rate of muscle strength improvement after surgery,and the KPS score at 3 months after surgery in the observation group were higher than those in the control group,and the differences were statistically significant(all P<0.05).The rate of newly-developed neurological dysfunction after surgery was lower than that of the control group(P<0.05).There were no significant differences in length of hospital stay,duration of surgery,or incidence of complications between the two groups(all P>0.05).The results of log-rank test showed that the survival rate of patients in the observation group at 6,12 and 18 month

关 键 词：神经胶质瘤 显微外科手术 治疗结果 神经导航 荧光素钠 高级别 

分 类 号：R739.4[医药卫生—肿瘤]