术中超声造影在颅脑胶质瘤切除中的临床应用探讨

发布时间：2018-06-02 22:45

本文选题：颅脑胶质瘤 + 术中超声　；参考：《新疆医科大学》2014年硕士论文

【摘要】：目的：探讨术中超声造影在颅脑胶质瘤手术中的临床应用。方法：66例经CT或MRI疑似胶质瘤患者(最终经病理证实收集61例),切除前经知情同意告知患者超声造影益处及风险并自愿选择术中进行超声造影检查的患者(实验组)及不愿或不能进行超声造影检查的患者(对照组)。术者手持探头,观察肿瘤二维超声基本特征；超声造影检查在行常规超声后,观察肿瘤超声造影特征；术后定期采用MRI进行判定两组治疗效果,对两种情况下脑胶质瘤切除残留率以及24月内肿瘤复发率进行对照研究,并按照胶质瘤级别分层后分析两组残留率、复发率是否存在差异。结果：(1)二维超声显示低、高级别的胶质瘤的边界、形态、坏死有统计学差异(P0.05)。二维超声上低、高级别胶质瘤的瘤周水肿无统计学差异(P0.05),而超声造影两者具有统计学差异(P0.05)。高级别胶质瘤的造影达峰时间早于低级别胶质瘤,组间比较有统计学差异(P0.05)。(2)胶质瘤术后定期检查MRI,实验组与对照组总体残留率及高级别胶质瘤残留率比较均有统计学意义(χ2=7.289,P0.05；χ2=5.903,P=0.015)；而低级别胶质瘤残留率比较无统计学差异(χ2=0.873,P0.05)。术后随访24月内实验组及对照组的总体及低级别胶质瘤复发率比较无统计学差异(χ2=3.755,P0.05；χ2=0.006,P=0.939),高级别胶质瘤复发率比较有统计学差异(χ2=4.521,P0.05)。结论：(1)术中常规超声及超声造影联合应用,不同级别的胶质瘤具有不同的声像图特征,为胶质瘤手术过程中初步判断胶质瘤级别提供较为客观的诊断依据。(2)术中超声造影指导胶质瘤手术具有常规超声无法比拟的优势,尤其是对于高级别胶质瘤,可以显著提高治疗效果,降低肿瘤残留率及复发率,能为胶质瘤切除术的疗效判定提供客观可靠的依据。
[Abstract]:Objective: to investigate the clinical application of intraoperative contrast-enhanced ultrasound in the operation of brain glioma. Methods Sixty-six patients suspected of glioma by CT or MRI (61 cases were confirmed by pathology, informed of the benefits and risks of contrast-enhanced ultrasound before resection and voluntarily selected for intraoperative contrast-enhanced examination) (experimental study) Group B) and patients who were unwilling or unable to perform contrast-enhanced ultrasonography (control group). The basic features of two-dimensional ultrasound were observed by using a probe held by the operator, the characteristics of ultrasound were observed after conventional ultrasound was performed, and MRI was used regularly after operation to determine the therapeutic effect of the two groups. The residual rate of glioma resection and the recurrence rate within 24 months were compared. The residual rate and recurrence rate of the two groups were analyzed according to the grade stratification of glioma. Results two dimensional ultrasound showed the boundary, morphology and necrosis of low and high grade gliomas (P 0.05). There was no significant difference in peritumoral edema between high grade gliomas and two dimensional ultrasonography (P 0.05), but there was a significant difference in contrast echocardiography between the two groups (P 0.05). The peak time of high grade gliomas was earlier than that of low grade gliomas. There was a statistical difference between the two groups (P 0.05). MRI was examined regularly after operation. There was significant difference between the experimental group and the control group in overall residual rate and high grade glioma residual rate (蠂 2 7. 289%, P 0. 05; 蠂 2 5. 903, P 0. 015, P 0. 015), but there was no significant difference in the residual rate of low grade glioma (蠂 2. 873%, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05). There was no significant difference in the overall and low grade glioma recurrence rates between the experimental group and the control group within 24 months of follow-up (蠂 2 + 3.755% P 0.05; 蠂 2 0. 006% P 0. 939). The recurrence rate of high grade gliomas was significantly different (蠂 2 4. 521% P 0 05). Conclusion conventional ultrasound and contrast-enhanced ultrasonography are used in combination with different grades of gliomas with different sonographic features. In order to provide a more objective diagnostic basis for the grade of gliomas during glioma surgery, intraoperative contrast-enhanced ultrasound has an incomparable advantage over conventional ultrasound in guiding glioma surgery, especially for high-grade gliomas. It can significantly improve the therapeutic effect, reduce the tumor residual rate and recurrence rate, and provide an objective and reliable basis for the evaluation of the curative effect of glioma resection.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1

【参考文献】