荧光素钠引导手术切除脑胶质瘤的临床研究

发布时间：2018-02-09 19:53

本文关键词： 恶性胶质瘤荧光素钠全切率无进展生存期　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：神经胶质瘤是最常见的原发性恶性脑瘤，有很大的几率出现不良的预后。高级别胶质瘤的患者1年和2年生存率只有53.7%和14.6%，显示了在最近几年高级别胶质瘤的患者越来越多，并且因为其难治性，发病率，复发率，死亡率高和低治愈率的特性，大多数患者有非常差的预后。恶性胶质瘤的治疗依然是神经外科学者所面临的难题。现在脑胶质瘤普遍采用手术治疗，放疗，化疗等综合治疗方案。临床研究表明外科手术切除仍然被认为是胶质瘤治疗的第一方案，并且被认为是影响胶质瘤患者预后及生存的最重要因素。但是，由于肿瘤的侵袭性生长的生物学行为使得术中难以确定肿瘤和正常脑组织的界限，从而使完全切除这些肿瘤更加难以实现，因此，如何在手术过程中可以更加直观地确定肿瘤组织，尽最大可能切除肿瘤是手术的关键所在。荧光素钠引导新技术在胶质瘤切除术中应用，，可以显著提高肿瘤全切率，改善患者无进展生存期预后。目的：本研究的目的是为了评估荧光素钠引导脑胶质瘤切除的临床效用。方法：在此我们将2011年7月至2013年7月收入我科的经术前核磁共振诊断为胶质瘤患者60例随机分组。30例胶质瘤患者在术中行荧光素钠引导肿瘤切除术，并根据肿瘤组织的荧光素钠染色强度（暗黄色，浅黄色，无染色）判断肿瘤边界并以此为依据切除肿瘤。30例胶质瘤患者是根据术者经验常规显微操作切除肿瘤。计数资料、计量资料分别采用X2检验，t检验进行统计学分析，比较两组患者的全切率、KPS评分、手术时间及住院时间。结果： 1、荧光素钠引导手术组术中肿瘤切除病理与术后影像学回顾切除肿瘤程度一致。荧光引导手术组与传统手术组术后复查CT或MRI提示荧光引导组患者肿瘤的切除更完全。 2、荧光素钠组胶质瘤全切26例（86.7%），传统组手术全切17例（56.7%），两组全切率的差异有显著性（P0.05）；在非功能区两组全切率差异有统计学显著性（P0.05）。 3、在功能区上，荧光素钠引导组术前术后KPS评分差异有显著性（P0.05），而常规手术组差异无显著性（P0.05）。结论： 1、荧光素钠引导新技术可显著提高脑恶性胶质瘤的全切率。 2、对于胶质瘤位于功能区的患者，我们结合神经电生理监测，可显著提高患者术后KPS评分。 3、术后结合替莫唑胺化疗及放疗可明显延长患者无进展生存期。 4、我们不推荐低级别胶质瘤使用荧光素钠作为术中荧光引导。
[Abstract]:Gliomas are the most common primary malignant brain tumors, with a high risk of poor prognosis. The 1-year and 2-year survival rates for high-grade gliomas are only 53.7% and 14.6, indicating a growing number of high-grade gliomas in recent years. And because of its refractory, morbidity, relapse rate, high mortality rate and low cure rate, Most patients have a very poor prognosis. The treatment of malignant gliomas is still a problem for neurosurgeons. Clinical studies show that surgical resection is still considered the first treatment for glioma and is considered to be the most important factor affecting the prognosis and survival of glioma patients. Because the biological behavior of aggressive growth of tumors makes it difficult to determine the boundaries between tumors and normal brain tissue during the operation, thus making complete excision of these tumors more difficult to achieve, How to determine tumor tissue more intuitively and remove tumor as far as possible is the key to the operation. The application of new technique guided by fluorescein sodium in glioma resection can significantly improve the total removal rate of the tumor. To improve the prognosis of progression-free survival. Objective:. The aim of this study was to evaluate the clinical efficacy of sodium fluorescein in glioma resection. Methods:. From July 2011 to July 2013, 60 patients with glioma diagnosed by preoperative MRI were randomly divided into three groups. 30 gliomas were treated with sodium fluorescein guided tumor resection during operation. According to the intensity of fluorescein sodium staining (dark yellow, light yellow, no staining) in tumor tissue, the tumor boundary was determined and the tumor was resected in 30 patients with glioma according to the experience of operation. The data were statistically analyzed by X _ 2 test and t test, and the KPS score, operation time and hospitalization time were compared between the two groups. Results:. 1. The degree of tumor resection during operation was the same as that in imaging review. Ct or MRI showed that the resection of tumor was more complete in fluorescence guided operation group and traditional operation group. 2. In the sodium fluorescein group, there were 26 cases of glioma with total resection and 17 cases of traditional group with total resection rate of 56.7%. There was a significant difference in the rate of total resection between the two groups (P 0.05), and the difference between the two groups in non-functional areas was statistically significant (P 0.05). 3. In the functional area, there was a significant difference in KPS score between the two groups before and after operation, but there was no significant difference between the conventional operation group and the routine operation group. Conclusion:. 1. The new technique of sodium fluorescein guidance can significantly improve the total removal rate of malignant gliomas. 2. For the patients with gliomas located in the functional area, we can significantly improve the postoperative KPS score in combination with electrophysiologic monitoring. 3, postoperative combined with temozolidomide chemotherapy and radiotherapy can significantly prolong the progression-free survival of patients. 4. We do not recommend the use of sodium fluorescein for intraoperative fluorescence guidance in low-grade gliomas.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

【参考文献】