小剂量荧光素钠术中显影辅助切除脑胶质瘤的临床研究

Clinical study of intraoperative contrast-assisted resection of glioma with low-dose sodium fluorescein

目的 探讨小剂量荧光素钠术中显影辅助切除脑胶质瘤的临床疗效。方法 回顾性分析2018年10月至2021年1月在广西医科大学附属肿瘤医院神经外科行外科手术治疗的100例脑胶质瘤患者的临床资料。根据不同的手术方式分为观察组和对照组,其中观察组47例患者采用小剂量荧光素钠(1 mg/kg)引导下的脑胶质瘤显微切除术,对照组53例患者在常规显微镜下进行脑胶质瘤切除术。比较两组患者的全切率、术后3个月Karnofsky(KPS)评分、手术时间、术中出血量以及术后并发症等情况。结果 两组患者的手术均顺利完成,其中观察组全切率为80.9%,明显高于对照组的58.5%(P=0.028)。校正可能的混杂因素后,观察组全切率是对照组的6.94倍(OR=6.94,95%CI:1.96~24.65,P=0.003);观察组术后3个月的KPS评分较对照组高7.94分(β=7.94,P=0.037)。观察组和对照组平均手术时间、中位术中出血量比较差异均无统计学意义(均P>0.05)。两组患者主要并发症均为颅内感染以及术后出血且发生率差异均无统计学意义(均P>0.05)。结论 与常规显微镜下的脑胶质瘤切除术相比,小剂量荧光素钠引导下的显微切除术可提高脑胶质瘤的全切率,并改善患者的术后生活质量。

ObjectiveTo investigate the clinical efficacy of intraoperative contrast-assisted resection of glioma with low-dose sodium fluorescein.MethodsThe clinical data of 100 patients with glioma who underwent surgical treatment in the Department of Neurosurgery,Guangxi Medical University Cancer Hospital from October 2018 to January 2021 were retrospectively analyzed. The patients were divided into the observation and the control groups according to different surgical methods, by which 47 patients in the observation group underwent microsurgical glioma resection under the guidance of low-dose sodium fluorescein(1 mg/kg), and 53 patients in the control group underwent glioma resection under the conventional microscope. The two groups were compared with respect to total resection rate, Karnofsky score(KPS score) at 3 months postoperatively, operative time, intraoperative bleeding, and postoperative complications.Results The surgery was successfully completed in both groups, and the total resection rate in the observation group was 80.9%, which was significantly higher than 58.5% in the control group(P=0.028). After correcting for possible confounding factors, the total resection rate of the observation group was 6.94 times higher than that of the control group(OR=6.94, 95%CI: 1.96-24.65, P=0.003);the KPS score of the observation group at 3 months after surgery was 7.94 points higher than of the control group(β=7.94, P=0.037). There was no significant differences in the mean operative time and median intraoperative bleeding between the two groups(all P>0.05). The main complications in both groups were intracranial infection and postoperative bleeding, and the incidence was not significantly different(all P>0.05).ConclusionsCompared with conventional microscopic glioma resection, microscopic resection under low-dose sodium fluorescein guidance can improve the total resection rate of gliomas and improve the postoperative life quality of patients.