神经导航联合术中荧光素钠引导技术治疗脑转移瘤的临床研究  

Clinical study of neuronavigation combined with intraoperative fluorescein sodium guided technique in the surgery of brain metastases

作　　者：王忠 张晓军 张瑞剑 韩志桐 杨蔚然 张之龙 宋钰辉 Wang Zhong;Zhang Xiaojun;Zhang Ruijian;Han Zhitong;Yang Weiran;Zhang Zhilong;Song Yuhui(Department of Neurosurgery,Inner Mongolia 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：《中华实验外科杂志》2024年第10期2337-2340,共4页Chinese Journal of Experimental Surgery

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

摘　　要：目的:探讨神经导航联合术中荧光素钠在脑转移瘤手术中的应用。方法:选取2018年1月至2023年12月于内蒙古自治区人民医院神经外科行手术治疗的80例脑转移瘤患者,按是否术中使用荧光素钠分为观察组和对照组并进行回顾性分析,术前均完善头部计算机断层扫描(CT)、核磁共振平扫与增强(MRI)及磁共振血管造影(MRA)、弥散加权成像(DWI)、弥散张量成像(DTI)等检查,将影像资料导入博医来导航软件中进行图像融合,确定肿瘤位置及与锥体束、大血管的空间关系,确定手术导航计划。对照组在神经导航下行常规显微镜下手术,观察组术中将神经导航与荧光素钠联合使用,通过在蔡司Pentero900显微镜黄荧光模式下显示肿瘤与脑组织的边界进行肿瘤切除,比较两组的肿瘤切除率,术后KPS评分改善情况,术后新发功能障碍、术后并发症、手术时间、住院时间,组间比较采用χ^(2)检验或t检验。结果:观察组在肿瘤切除方面高于对照组(90%比55%),差异有统计学意义(χ^(2)=6.144,P<0.05);观察组术后KPS评分改善情况高于对照组(85%比55%),差异有统计学意义(χ^(2)=4.286,P<0.05);观察组术后新发功能障碍低于对照组(10%比40%),差异有统计学意义(χ^(2)=4.800,P<0.05);观察组术后并发症低于对照组(35%比45%),差异无统计学意义(χ^(2)=2.294,P>0.05);观察组手术时间[(216.65±56.76)min]低于对照组[(225.62±37.68)min],差异无统计学意义(t=0.589,P>0.05);观察组住院时间[(21.48±3.23)d]低于对照组[(22.43±2.34)d],差异无统计学意义(t=1.065,P>0.05)。结论:多模态神经导航联合术中荧光素钠在脑转移瘤手术中可以提高肿瘤切除率,减少术后新发功能障碍,改善患者生活质量与预后。Objective:To study the application of neuronavigation combined with intraoperative fluorescein sodium in brain metastases surgery.Methods:From January 2018 to December 2023,80 patients with brain metastases were divided into the observation group and control group according to whether fluorescein sodium was used during the operation.All patients underwent head CT,MRI and enhancement,MRA,MRV,DWI,and DTI before operation.The image data was imported into Brainlab nervous system navigation software before operation for image fusion,determine the specific location of tumor and spatial relationship with pyramidal bundles and large vessels,determine the surgical navigation plan.Fluorescein sodium allergy test was performed before operation,followed by intravenous injection(2 mg/kg).Neuronavigation was used in conjunction with fluorescein sodium intraoperatively to perform tumor resection by displaying the border between tumor and brain tissue in the fluorescence mode of the Pentero900 Zeiss microscope.The tumor resection rate,postoperative KPS score improvement,postoperative new dysfunction and postoperative complications were compared between the two groups using 2 test.The time of operation and the time of hospitalization were tested by t test.Results:The observation group showed a significant superiority over the control group in tumor resection(90%vs.55%,χ^(2)=6.144,P<0.05);postoperative KPS scores in the observation group improved compared to the control group(85%vs.55%,χ^(2)=4.286,P<0.05).Postoperative new-onset functional impairments decreased in the observation group compared to the control group(10%vs.40%,χ^(2)=4.800,P<0.05);the observation group had a decrease in postoperative complications compared to the control group(35%vs.45%,χ^(2)=2.294,P>0.05).The surgical time was shorter in the observation group[(216.65±56.76)min]compared to the control group[(225.62±37.68)min,t=0.589,P>0.05].The length of hospitalization in the observation group[(21.48±3.23)d]was lower than that in the control group[(22.43±2.3

关 键 词：神经导航 荧光素钠 脑转移瘤 

分 类 号：R739.41[医药卫生—肿瘤]