摘要
目的 探讨弥散张量成像（DTI）联合荧光素钠染色技术在脑功能区高级别胶质瘤（HGG）手术中的应用价值.方法 回顾性纳入2014年10月至2016年12月郑州大学第一附属医院神经外科收治的95例脑功能区HGG患者,其中49例（观察组）术前行增强MRI与DTI,术中应用荧光素钠染色技术引导切除肿瘤;46例（对照组）术前行MRI平扫与增强扫描,按传统方法切除肿瘤.术后72 h内复查MRI评估肿瘤切除程度,1个月后评估患者的肌力及Karnofsky功能状态评分（KPS）.结果 观察组的肿瘤全切除率明显高于对照组（83.7％对比45.7％,P＜0.001）.观察组肌力下降的比率明显低于对照组（20.4％对比47.8％,P=0.005）,而KPS评分改善率明显高于对照组（73.5％对比47.8％,P=0.029）.观察组应用荧光素钠染色技术识别胶质瘤范围的灵敏度为91.7％（44/48）,特异度为90.0％ （45/50）.结论 对脑功能区HGG患者应用DTI联合荧光素钠染色技术能够引导最大限度地切除肿瘤,最大程度地保护脑白质纤维束,降低手术致残率,提高患者的生命质量,值得临床推广.
Objective To investigate the clinical application of magnetic resonance diffusion tensor imaging （DTI） combined with fluorescein sodium dyeing （FLS） in surgery of high-grade gliomas （HGG） in functional brain areas.Methods From October 2014 to December 2016,a total of 95 cases of HGG in functional brain areas were admitted to Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University and their data were retrospectively analyzed.In the observation group,49 patients underwent preoperative MRI scanning,enhancement and DTI,and FLS was applied to guide the removal of tumor;in the control group,46 patients received MRI scanning and enhancement preoperatively,and the tumor was removed by conventional operation.Postoperatively,all patients underwent MRI scanning and enhancement within 72 hours for assessment of the resection extent.The changes of muscle strength and Karnofsky performance scale （KPS） scores were evaluated at 1 month post surgery.Results The rate of total resection was significantly higher in the observation group （83.7%） than in control group （45.7%） （P 〈 0.001）.The rate of muscle strength reduction post surgery was significantly lower in observation group than in control （20.4% vs.47.8%,P =0.005）.KPS scores in the observation group were significantly higher than those in control （73.5% vs.47.8%,P =0.029）.In the observation group,the sensitivity of FLS in identifying tumor tissue was 91.7% （44/48） and the specificity was 90.0% （45/50）.Conclusion The application of DTI combined with FLS could facilitate maximal resection of HGG in functional brain areas with a minimal loss of fiber bundles,reduce the disability rate and improve the quality of postoperative life,which is of great clinical significance.
作者
陈迪
马斯奇
吴力新
朱旭强
李雪元
李天豪
阎静
杨召阳
闫东明
Chen Di;Ma Siqi;Wu Lixin;Zhu Xuqiang;Li Xueyuan;Li Tianhao;Yan Jing;Yang Zhaoyang;Yan Dongming(Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 400052, Chin)
出处
《中华神经外科杂志》
CSCD
北大核心
2018年第4期353-358,共6页
Chinese Journal of Neurosurgery
基金
河南省科技攻关计划（国际科技合作）项目（172102410015）
河南省高等学校重点科研项目（18A320077）
关键词
神经胶质瘤
弥散张量成像
神经外科手术
荧光素钠
脑功能区
Glioma
Diffusion tensor imaging
Neurosurgical procedures
Fluoresceinsodium
Brain functional areas
