摘要：

目的 探讨术中高场强MRI联合荧光引导下脑胶质瘤切除术的有效性和安全性。方法 纳入吉林大学白求恩第一医院2017年6月至2018年6月收治的53例脑胶质瘤患者，其中33例（62.26%）肿瘤位于重要脑功能区（运动区17例，语言区11例，丘脑5例），分别行荧光引导下脑胶质瘤切除术（荧光引导组，28例）和术中高场强MRI联合荧光引导下脑胶质瘤切除术（联合组，25例）。结果 本组53例患者肿瘤全切除42例（79.25%），次全切除11例（20.75%）；33例肿瘤位于重要脑功能区患者，肿瘤全切除25例（75.76%），次全切除8例（24.24%）；经术后病理证实星形细胞瘤（WHOⅡ级）12例（22.64%），间变性星形细胞瘤（WHOⅢ级）17例（32.08%），胶质母细胞瘤（WHOⅣ级）24例（45.28%）；术后出现言语障碍16例（30.19%）、短暂性肢体活动障碍21例（39.62%）、精神障碍6例（11.32%）、颅内感染8例（15.09%）、少量硬膜外出血2例（3.77%），无死亡病例。联合组手术时间长于荧光引导组[（3.79±1.14）h对（2.53±1.04）h；t=-4.718，P=0.000]，肿瘤全切除率高于荧光引导组[92%（23/25）对67.86%（19/28）；χ²=4.681，P=0.031]，WHO分级比例组间差异具有统计学意义（χ²=2.041，P=0.036），而重要脑功能区肿瘤全切除率[88.89%（16/18）对60%（9/15）；Fisher确切概率法：P=0.101]和术后并发症发生率[37.73%（20/53）对62.26%（33/53）；χ²=0.179，P=1.000]组间差异无统计学意义。术后平均随访9个月，肿瘤复发11例（20.75%），联合组与荧光引导组肿瘤复发率差异无统计学意义[12%（3/25）对28.57%（8/28）；χ²=2.205，P=0.138]。结论 术中高场强MRI联合荧光引导技术可以显著提高脑胶质瘤全切除率，同时尽可能保留重要脑功能区和神经结构，提高患者生活质量和延长无进展生存期。

关键词: 神经胶质瘤, 磁共振成像, 荧光素, 神经外科手术

Abstract:

Objective To investigate the efficacy and safety of intraoperative high-field MRI combined with fluorescence-guided glioma resection. Methods A total of 53 patients with glioma admitted to The Fisrt Bethune Hospital of Jilin University from June 2017 to June 2018 were enrolled, including 33 patients (62.26%) whose tumors were located in important brain functional areas (17 cases in motor area, 11 cases in language area, 5 cases in thalamus). Glioma resection was performed under fluorescence-guided (fluorescence guidance group, n=28) and intraoperative high-field MRI combined with fluorescence-guided glioma resection (combined group, n=25). Results Total tumor resection was performed in 42 cases (79.25%) and subtotal tumor resection in 11 cases (20.75%). Of the 33 patients whose tumors were located in important brain functional areas, total resection was performed in 25 cases (75.76%) and subtotal resection in 8 cases (24.24%). There were 12 cases (22.64%) of astrocytoma (WHO grade Ⅱ), 17 cases (32.08%) of anaplastic astrocytoma (WHO grade Ⅲ) and 24 cases (45.28%) of glioblastoma (WHO grade Ⅳ) were confirmed by postoperative pathology. There were 16 cases of speech disorder (30.19%), 21 cases of transient limb movement disorder (39.62%), 6 cases of mental disorder (11.32%), 8 cases of intracranial infection (15.09%), 2 cases of small epidural hemorrhage (3.77%), and no death after the operation. The operation time of combined group was longer than that of fluorescence guidance group[(3.79±1.14) h vs. (2.53±1.04) h; t=-4.718, P=0.000]. The tumor total resection rate in the combined group was higher than that in fluorescent guidance group[92% (23/25) vs. 67.86% (19/28); χ²=4.681, P=0.031], the WHO grade had significant difference between 2 groups (χ²=2.041, P=0.036), but the tumor total resection rate in important brain functional areas[88.89% (16/18) vs. 60% (9/15); Fisher's exact probability:P=0.101] and the incidence of postoperative complications[37.73% (20/53) vs. 62.26% (33/53); χ²=0.179, P=1.000] were no significant difference between 2 groups. In the mean follow-up of 9 months, 11 patients (20.75%) had tumor recurrence. There was no significant difference in the recurrence rate between combined group and fluorescence guidance group[12% (3/25) vs. 28.57% (8/28); χ²=2.205, P=0.138]. Conclusions Intraoperative high-field MRI combined with fluorescence guidance can significantly improve the total resection rate of glioma, while preserving important brain functional areas and neural structures as much as possible, improving the quality of life and prolonging the progression-free survival of patients.

Key words: Glioma, Magnetic resonance imaging, Fluorescein, Neurosurgical procedures