5-氨基乙酰丙酸荧光引导显微手术切除人脑胶质瘤

Fluorescence-guided microsurgical resection of human glioma with using 5-aminolevulinic acid

目的探讨临床应用荧光物质引导的显微手术切除人脑胶质瘤的要点,评估该技术的安全性及疗效。方法2006年4月至2006年10月术前经CT或MRI证实胶质瘤的11例病人接受了荧光引导胶质瘤手术。男5例,女6例。年龄35～66岁,平均48．5岁。术前应用5-氨基乙酰丙酸（5-ALA）,术中根据所提供的荧光影像判定肿瘤边界并切除肿瘤。根据不同荧光强度取材进行HE染色以检测手术切除情况。术后行MRI检查以确定肿瘤的切除情况。结果胶质瘤在荧光光源的照射下被激发出红色荧光,而正常脑组织不发光。荧光强度高的肿瘤组织HE染色显示含有大量的肿瘤细胞,并可见血管内皮细胞增生,荧光强度较弱或者没有荧光的区域仅有少量的肿瘤细胞和血管内皮细胞增生。病人术后的MRI检查证实肿瘤切除比较完全。结论该方法能够有效的切除胶质瘤,并为手术者提供客观的肿瘤边界,提高了手术切除率。对该方法的确切评估尚需对手术病人进行长期随访。

Objecitive The study was evaluate the effectiveness of fluorescence-guided microsurgical resection of human glioma, and investigate this technical tip and safety. Methods From April,2006 to October,2006,11 patients （ 6 women and 5 men; mean age 48.5years old ; age range, 35 - 66 years old）with human glioma underwent fluorescence-guided microsurgical resection by 5-ALA. The patients with glioma received 5-ALA before operation. The patients with glioma received 20 mg/kg 5-ALA before operation. The fluorescent regions of glioma were resected through a fluorescein surgical microscope after administration of fluoreseer. To evaluate the effectiveness of the resection, operative findings were compared with histological findings from different fluorescent areas of these glioma. All patients were studied with MRI for detection of residual tumor. Results The rate of fluorescence positive was 100% in all cases. The viable tumor tissue was distinguished by its deep fluorescence, whereas normal brain tissue was not stained. Our histological findings revealed a large number of tumor cells and a conspicuous vascular reaction such as proliferation of endothelial cells in the fluorescein-positive area. On the other hand, the fluorescein-negative area showed only a small number of tumor cells and little vascular reaction. MRI after operation result demonstrated the completeness of tumor removal in these patients. Conclusion These results suggest that fluorescence-guided microsurgical technique by administrating 5-ALA may be practical and useful for resection human gliomas. By this mothod, surgeon can easily and rapidly gained objective standard to judge the extent of removal in the operation. The technique may also be useful in identifying tumour margins during surgery. Follow-up on patients who have undergone this surgery should be done to evaluate precisely effectiveness of this technique.