术中超声判定脑胶质瘤边界的应用价值

Value of intra-operative ultrasound in detecting the boundaries of intracranial gliomas

目的探讨术中超声（IOUS）在脑胶质瘤手术中判定肿瘤边界中的应用价值。方法幕上胶质瘤患者105例，择期手术患者88例，其中男42例，女46例，年龄15～67岁（平均41岁），手术中肿瘤切除前、后均进行B超探查，判定肿瘤边界并对可疑回声进行活组织检查，经病理学最后诊断，术后3d内进行MRI复查，判定肿瘤切除程度。结果88例患者均在B超检查下进行手术，肿瘤近全切除83例，大部切除5例。病理学诊断为胶质瘤Ⅱ级30例，Ⅲ级31例，Ⅳ级27例。术中B超发现可疑回声120处，经病理学证实为肿瘤101处。B超探查发现视野死角残存肿瘤17处，发现脑内挫裂伤（血肿）1例，无手术死亡，灵敏度80．1％，特异性69．8％。结论术中超声辅助确定胶质瘤边界，有一定的应用价值和优势，对低级别胶质瘤更具价值，并未显著增加手术时间及手术风险，可以作为术中常规应用。

Objective To evaluate the application of intra-operative ultrasound （IOUS） in detecting the boundaries of intracranial gliomas. Methods One hundred and five consecutive patients with supra-tentorial glioma were included, male： 42 cases, female： 46 cases, age ranged from 15-67years （mean 41 yrs）, intra-operative ultrasound B was used to detect tumour boundaries before and after resection in 88 cases, tissues with suspicious echo was taken for verification by histological examination. And repeated MRI scan was received within 3 day after operation to judge the resection extent. The result was judged by Ultrasound doctor, neurosurgeon and pathologist, respectively. Results Eighty-eight patients were operated assisted by IOUS B. Tumour was nearly total removed in 83 cases and subtotal removed in 5 cases. Histological examination showed WHO Grade Ⅱ 30 cases, Grade Ⅲ 31 cases and Grade Ⅳ 27 cases. One hundred and twenty samples were taken and 101 were verified as tumours. And residuary tumours were found in 17 cases and brain contusion and laceration was found in 1 case. The sensitivity of IOUS was 80. 1% and the specificity was 69. 8% . Conclusions IOUS could produce a marked effect in judging boundaries of glioma, especially in low grade gliomas. IOUS could be a routine technique in intracranial glioma operation.