多模态影像融合联合术中荧光素钠引导治疗肺癌脑转移瘤的临床效果  

Clinical effect of multi-modality image fusion combined with intraoperative fluorescein sodium in the treatment of brain metastases from lung cancer

作　　者：王忠 张晓军 张瑞剑 韩志桐 杨蔚然 杨文博 陈云照 邢栋 王俊青 宋钰辉 Wang Zhong;Zhang Xiaojun;Zhang Ruijian;Han Zhitong;Yang Weiran;Yang Wenbo;Chen Yunzhao;Xing Dong;Wang Junqing;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：《中国综合临床》2024年第6期447-455,共9页Clinical Medicine of China

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：目的探讨功能神经导航多模态影像融合技术联合术中荧光素钠在肺癌脑转移瘤手术中的应用及其临床效果。方法以内蒙古自治区人民医院神经外科2020年1月至2024年1月应用多模态功能神经导航联合术中荧光引导技术显微镜下切除的40例肺癌脑转移瘤患者为观察组;另选取2016年1月至2019年12月内蒙古自治区人民医院收治的显微镜直视下切除的肺癌脑转移瘤患者40例为对照组。术前所有患者均接受头颅电子计算机X射线断层扫描(computed tomography, CT)、磁共振平扫与增强(magnetic resonance imaging, MRI)及磁共振血管造影(magnetic resonance angiography, MRA)、磁共振静脉造影(magnetic resonance venography, MRV)、磁共振弥散加权成像(magnetic resonance diffusion-weighted imaging, DWI)、磁共振弥散张量成像(magnetic resonance diffusion tensor imaging, DTI)序列扫描, 利用功能神经导航系统进行术前多模态图像融合, 以实现肿瘤病灶的三维显示, 并展示肿瘤与功能区及传导束及大血管的位置关系, 制定术前导航计划。手术前对患者进行荧光素钠过敏试验后, 术中静脉注射小剂量荧光素钠(2 mg/kg)。术中将神经导航与荧光素钠联合使用, 通过在Pentero 900蔡司显微镜560荧光模式下显示肿瘤组织与正常脑组织的边界进行肿瘤切除。两组均取肿瘤组织标本进行病理分型和免疫组化分析, 比较分析肿瘤切除程度、术后是否出现新发神经功能障碍、术后肌力改善情况、手术前后的KPS评分变化以及是否发生并发症等方面的差异。符合正态分布的计量资料以xˉ±s表示, 两组间均数比较采用独立样本t检验。计数资料计算百分率, 组间率比较采用χ^(2)检验。P<0.05为差异具有统计学意义。结果与对照组比较, 观察组患者的肿瘤全切除率[75.0%(30/40)]、术后3个月Karnofsky功能状态(Karnofsky performance status, KPS)评分[82.5%(33/40)]均优于对照ObjectiveTo explore the application and clinical efficacy of functional neural navigation multimodal image fusion technology combined with intraoperative fluorescein sodium in the surgery of lung cancer brain metastases.MethodsForty patients with lung cancer and brain metastasis admitted to the Department of Neurosurgery of Inner Mongolia Autonomous Region People's Hospital from January 2020 to January 2024 were collected as the observation group.Another 40 patients with lung cancer brain metastases who underwent microscopic resection at Inner Mongolia Autonomous Region People's Hospital from January 2016 to December 2019 were selected as the control group.All patients received head CT examination,head MRI examination,MRI enhanced sequence and MRA,MRV and DWI sequence scanning before operation.Functional neural navigation system was used to perform preoperative multi-modal image fusion to realize three-dimensional display of tumor lesions,and display the position relationship between tumor and functional areas,conduction bundles and large blood vessels,so as to make preoperative navigation plan.After conducting a fluorescein sodium allergy test on the patient before surgery,a small dose of fluorescein sodium(2 mg/kg)was intravenously injected during the operation.During the operation,neuro navigation was combined with fluorescein sodium to perform tumor resection by displaying the boundary between tumor tissue and normal brain tissue under a Pentero 900 Zeiss microscope 560 fluorescence mode.Both groups collected tumor tissue samples for pathological classification and immunohistochemical analysis,comparing and analyzing differences in tumor resection degree,postoperative occurrence of new neurological dysfunction,postoperative muscle strength improvement,changes in KPS scores before and after surgery,and the occurrence of complications.The metric data that conforms to normal distribution is represented by x¯±s,and the comparison of means between two groups is conducted using independent sample t-test.Calculate

关 键 词：肺癌脑转移 多模态影像融合术 功能神经导航 荧光素钠 肿瘤切除范围 

分 类 号：R734.2[医药卫生—肿瘤] R739.41[医药卫生—临床医学]