荧光素钠引导下高级别胶质瘤的手术治疗

Sodium fluorescein-guided surgery for high-grade gliomas

目的探讨荧光素钠显影在高级别胶质瘤手术中的应用价值。方法回顾性分析2013年12月至2014年12月收治的55例高级别胶质瘤的临床资料,均在荧光素钠显影引导下手术治疗,术中在荧光模式显微镜下,根据荧光显影的范围进行肿瘤边界判定并切除。术后3 d内行MRI增强扫描,根据瘤腔T1序列强化范围估算切除程度。结果肿瘤全切除45例(81.8%),次全切除6例,大部分切除4例。55例术后随访1~1.5年,失访4例,42例以死亡为结局,9例直至随访截止仍存活;6个月无进展存活率为63.6%,中位生存期为16.3个月。荧光素显影钠判断肿瘤边界的敏感性及特异性分别为89.2%和90.7%。结论荧光素钠显影可以帮助高级别胶质瘤术中判定肿瘤边界,提高手术疗效。

Objective To explore the value of sodium fluorescein dyeing to surgery for high-grade gliomas. Methods The clinical data of 55 patients with high-grade gliomas treated in our hospital from December, 2013 to December, 2014 were analyzed retrospectively. The curative effect of sodium fluorescein-guided operation on the high-grade gliomas was assessed. The tumorous boundaries were determined and the tumors were removed according to the range of sodium fluorescein dyeing under fluorescence pattern microscope. Enhanced MRI scanning was performed within 3 days after the operation, and the degree of resection of the tumors was estimated according to the enhanced range of tumor cavity on T1 sequence. The 6-month progression-free survival rate and median survival time were assessed. Resets The total tumor removal rate was 81.8% （45/55）. The 6-month progression-free survival rate was 63.6% （35/55） and the median survival time was 16.3 months in these patients. The following up was lost in 4 patients. Forty-two patients died and 9 patients survived at the end of following-up. The operation in which the tumorous boundaries were examined by frozen pathology, showed that the sensitivity and specificity of sodium fluorescein dyeing to the timorous boundaries reached 89.2% and 90.7% respectively. Conclusions Sodium fluorescein dyeing can help to judge the tumornous boundaries during the surgery for high-grade gliomas, and improve the curative effect on high-grade gliomas.