荧光引导下脑胶质瘤边界的组织病理学研究

Histopathological study of glioblastoma border during fluorescence-guided resection of glioma

目的 5-氨基乙酰丙酸(ALA)引导的荧光手术已应用于临床恶性脑胶质瘤的治疗,本实验的目的是探讨ALA荧光引导切除脑胶质瘤的荧光边界与侵袭性的关系。方法对11例胶质母细胞瘤患者麻醉诱导前3h给予口服ALA,术中使用荧光显微镜检测肿瘤荧光,根据有无荧光留取组织标本。利用免疫组化方法检测荧光组与非荧光组组织中侵袭性指标细胞粘附分子CD44(CD44-HCM)、基质蛋白酶-9(MMP-9)和肌腱蛋白(TN)的表达。结果 CD44-HCM、MMP-9和TN在荧光组织与无荧光组织中的阳性表达率有显著差异(P<0.01),与无荧光的组织相比,荧光组中CD44-HCM、MMP-9和TN表达的阳性率明显增加。结论 ALA诱导的肿瘤荧光边界与脑胶质瘤组织病理学边界相符,进一步表明,荧光引导手术能够有效的切除脑胶质瘤,并且为手术提供客观边界。

Objective To investigate the correlation between fluorescence boundary and invasion in ALA fluorescence-guided resection of glioma. Methods Eleven patients with glioblastoma multiforme received oral doses of ALA 3 h before induction of anesthesia. During glioma resection, positive fluorescence was noted by a modified neurosurgieal microscope. Tissue samples were taken from areas of positive and negative ALA fluorescence. Expressions of CD44-HCM, matrix metallopeptidase 9 （MMP-9）, tenascin （TN） were examined by immunohistochemistry. Results There were significant difference in expression of CD44-HCM, MMP-9 and tenascin between ALA-negative areas and ALA-positive areas. The positive rate and intensity of CD44-HCM, MMP-9 and TN were significantly higher in ALA-positive than that in ALA-positive areas. Conclusion There is a consistency between the fluorescence and the pathological margin. Fluorescence-guided surgery with ALA is helpful for the resection of glioma by identifying tumor margins.