多模态融合技术在延髓胶质瘤手术中的应用

Application of multimodal image fusion in microsurgical resection of medullary gliomas

目的 探讨多模态融合技术在提高延髓胶质瘤的切除程度及保护神经功能方面的作用.方法 回顾性分析2014年10月至2017年8月首都医科大学附属北京天坛医院神经外科收治的46例延髓胶质瘤患者的临床资料.根据是否应用多模态融合技术将其分为传统组（即采用传统影像学技术和显微外科手术,共23例）和多模态组[即采用弥散张量成像（DTI）、11C-蛋氨酸-正电子发射断层显像术/X线计算机体层成像（11C-MET-PET/CT）、术中导航、结合神经电生理监测的显微外科手术,共23例],对比分析两组患者的临床疗效.结果 两组患者的性别、发病年龄、肿瘤生长方式、术前肿瘤体积、术前Karnofsky功能状态评分、术后病理类型的差异均无统计学意义（均P＞0.05）.多模态组的肿瘤平均切除程度明显高于传统组[分别为（86.7±26.7）％、（61.8±32.9）％,P=0.007];多模态组术后1周气管切开或气管插管保留率显著低于传统组（分别为34.8％、69.6％,P=0.018）;术后1周呼吸机使用率和胃管保留率,传统组与多模态组间的差异均无统计学意义（均P＞0.05）.46例的随访时间为0.6 ～37.0个月,平均（12.9±11.4）个月.术后3个月气管切开或气管插管保留率和胃管保留率,传统组与多模态组间的差异均无统计学意义（均P＞ 0.05）.术后3个月呼吸机使用率,传统组与多模态组间的差异有统计学意义（分别为31.8％、5.0％,P=0.027）.结论 多模态融合技术可在不加重神经功能损伤的情况下提高延髓胶质瘤的切除程度;还可降低术后近期气管切开或气管插管保留率,促进患者术后远期呼吸功能恢复.

Objective To explore the application of multimodal image fusion in improvement of resection extent and protection of neurological function among cases of medullary gliomas.Methods The clinical data of 46 patients with medullary gliomas were retrospectively analyzed who were admitted to Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from October 2014 to August 2017.The patients were divided into conventional group （n =23） and multimodal group （n =23）.The clinical efficacy of both groups were compared and analyzed.Results The differences between two groups with regard to sex,age,growing patterns,preoperative tumor volume,preoperative KPS （Karnofsky performance status） score,postoperative pathology were not statistically significant （all P 〉 0.05）.The extent of resection in multimodal group was significantly higher than that of conventional group [（86.7 ± 26.7） % vs.（61.8 ± 32.9）%,P =0.007].At 1 week post operation,the rate of short-term tracheostomy or tracheal intubation in multimodal group was lower than that in conventional group （34.8% vs.69.6%,P=0.018）.The differences between two groups with regard to short-term ventilation support and gastrostomy tubes were not statistically significant （both P 〉 0.05）.The follow-up period of 46 patients lasted for 0.6-37.0 months with a mean of 12.9 ± 11.4 months.At 3 months post operation,the difference between two groups with regard to the retention rate of long-term tracheostomy or tracheal intubation and gastrostomy tubes was not statistically significant （all P 〉 0.05）.However,the rate of long-term ventilation support in multimodal group was lower than that in conventional group （31.8% vs.5.0%,P =0.027） at 3-month follow-up.Conclusion The technology of multimodal image fusion could improve the resection extent of medullary gliomas without aggravating the injury of neurological function,reduce postoperative retention rate of tracheotomy or tracheal intubation and promote postoperative recovery of the patient＇s long-term respiratory function.