术中超声造影在岛叶肿瘤手术中的应用

Application of contrast-enhanced intraoperative ultrasound in insular tumors surgery

目的探讨术中超声造影在岛叶肿瘤手术中的应用价值。方法58例岛叶肿瘤术中使用超声造影。对边界清楚、血供丰富的行经额或颞入路，对边界不清、血供不丰富的行经侧裂入路。术中判断已全切肿瘤，再次行超声检查，指导手术切除。结果术中超声发现35例肿瘤残留，行进一步手术切除。术中肿瘤全切率在超声引导下从40％提高到76％（P〈0．001）。术后MRI显示肿瘤残留有17例。术中超声与术后MRI在肿瘤残留检出率上有很好的一致性（Kappa=0．868）。结论术中超声造影有助于岛叶肿瘤手术人路的选择，监测肿瘤切除程度，提高肿瘤切除率，实现最大限度安全切除肿瘤的目标。

Objective To exploring the value of contrast-enhanced intraoperative ultrasound （CE-IOUS） in the surgery of insular tumors. Methods A total of 58 surgical patients with insular tumors were enrolled in this study. CE-IOUS was performed to detect the tumor and the vascular structure inside and around tumors, before opening dura matter and after craniotomy. Transfrontal or temporal approach was chosen if the tumor had a clear boundary with rich vessel supplying, and transsylvian approach was used if tumor shown an unclear boundary with less vessel. The primary resection finished when complete resection was judged by surgeons. Then repeated ultrasonography was performed to detect the residuals for a maximal resection of tumor. Results In this study, trans-frontal or temporal approach was used in 22 patients and trans-sylvian approach was adopted in 36 patients by the guide of CE-IOUS. Thirty-five out of 58 cases was observed residuals by uhrasonography after primary resection. And 21 cases of them were undergone expand resection. The gross total resection was achieved in 76% patients with the application of CE-IOUS, comparing with 40% of total resection on the primary resection before CE-IOUS. The surgical extent was improved significantly by CE-IOUS（ P 〈 0. 001 ）. And postoperative MR imaging revealed tumor residuals in 17 cases. The Kappa value for inter-method agreement was 0. 868. The similar detection of tumor residuals was achieved both in intraoperative ultrasound and postoperative MR imaging. Five patients had motor dysfunction after operation, and two of them had a complete recovery on the one month postoperative follow-up. Four patients had transit dysfunction of language, and only one patient still had aphasia one month after surgery. Conclusion CE-IOUS could provide useful information about the boundary,consistence and vessel supplying of insular tumors, which help for the decision of surgical approach. And a maximal and safe resection would be achieved by the application of repeated ultrasounography in the operation.