荧光显微镜在颅内恶性肿瘤切除术中的应用

Application of fluorescein sodium combined with fluorescence microscope to resection of intracranial malignant tumors

目的探讨小剂量荧光素钠(FLS)和560 nm荧光显微镜在切除颅内恶性肿瘤的中应用效果。方法回顾性分析2016年9月至2018年2月手术治疗的51例颅内恶性肿瘤的临床资料。均在全麻诱导后静脉注射FLS(5 mg/kg),在560 nm荧光显微镜下判断肿瘤边界指导完成肿瘤切除。结果 51例中,胶质母细胞瘤33例,间变性星形细胞瘤6例,转移瘤4例,间变性少突胶质细胞瘤3例,胶质肉瘤3例,髓母细胞瘤2例。术中荧光均显影,明显提高肿瘤边界的可视化。肿瘤全切除32例,次全切除13例,部分切除6例。51例无任何过敏反应或其他不良反应。术后随访5～16个月,中位随访时间为9.5个月。术后KPS评分提高16例,下降15例,与术前相同20例。结论应用小剂量FLS联合560 nm荧光显微镜辅助切除颅内恶性肿瘤安全、有效,有助于辨别肿瘤边界,提高肿瘤切除程度。

Objective To explore the technique of low dose fluorescein sodium (FLS) combined with yellow 560 nm fluorescence microscope-assisted neurosurgery for intracranial malignant tumors.Methods Fifty-one patients with intracranial malignant tumors diagnosed before the surgery were treated by low dose FLS combined with yellow 56 nm fluorescence microscope-assisted neurosurgery in the Department of Neurosurgery of Xinjiang Uygur Autonomous Region People's Hospital from September 2016,to February,2018.Of 51 patients,33 had glioblastomas,6 anaplastic astrocytmas,4 metastatic tumors,3 anaplastic oligodendrocytomas,3 glial sarcomas and 2 medulloblastoma.Results The fluorescence developed and the visualization of tumorous boundary was improved during the operation in all the patients.There were no allergic or other adverse reactions in all the patients.Of 51 patients,32 received the total resection of the tumors,13 subtotal and 6 partial.The median Karnofsky performance scale (KPS) score was 80.0 point in these 51 patients after the operation.The KPS score was improved in 16 patients,decreased in 15 and unchanged in 20 after the operation.Conclusion The application of low dose FLS to the neurosurgery is safe and helpful to identification of the tumorous boundary and increase in the extent of tumor resection in the patients with intracranial malignant tumors.