神经导航联合荧光素钠在低级别胶质瘤手术中的应用

Application of neuronavigation combined with fluorescein sodium in low-grade glioma surgery

目的:探讨神经导航联合荧光素钠术中显影辅助在低级别胶质瘤手术中的安全性和有效性。方法:将显微镜下常规手术的21例低级别胶质瘤(low-grade glioma, LGG)患者临床资料归为常规手术组,分别使用5 mg/kg(常规剂量组21例)和1 mg/kg(小剂量组25例)的荧光素钠(fluorescein sodium, FLS)联合神经导航手术的46例LGG患者纳入研究,比较3组手术效果及术后6个月KPS评分。结果:常规剂量组、小剂量组、常规手术组的肿瘤全切除率分别为81.0%(17/21)、76.0%(19/25)、42.9%(9/21),对3组肿瘤切除程度、手术时间、出血量、术后6个月KPS评分进行两两对比,常规剂量组、小剂量组分别与常规手术组比较差异均有显著性(P<0.05),常规剂量组与小剂量组比较差异均无显著性(P>0.05)。3组并发症比较差异均无显著性(P>0.05)。常规剂量组、小剂量组显影率分别为76.2%(16/21)、68.0%(17/25),2组比较差异均无显著性[(χ^(2)=1.665,P=0.645)、(χ^(2)=0.378,P=0.539)],2组显影与神经导航一致性比较差异无显著性(χ^(2)=0.874,P=0.350)。结论:2种剂量(5 mg/kg、1 mg/kg)的FLS在LGG术中可实现较好的荧光显影效果,与神经导航的联合应用,能提高肿瘤全切率、改善患者预后。

Objective:To evaluate the safety and efficacy of intraoperative neuronavigation combined with sodium fluorescein in low-grade glioma surgery.Methods:The clinical data of 21 patients with low-grade glioma(LGG)were classified into routine operation group,forty-six patients with LGG were enrolled in the study using fluorescein sodium(FLS)at a dose of 5 mg/kg(21 patients in the conventional dose group)and 1 mg/kg(25 patients in the low dose group)in combination with neuronavigation surgery,respectively,the operative effect and KPS score at 6 months after operation were compared among the 3 groups.Results:The total tumor resection rates of the conventional dose group,the low dose group and the conventional surgery group were 81.0%(17/21),76.0%(19/25)and 42.9%(9/21),respectively,the extent of tumor resection,operative time,blood loss and KPS score at 6 months after operation were compared among the 3 groups,there was significant difference between the routine dose group and the low dose group(P<0.05),but there was no significant difference between the routine dose group and the low dose group(P>0.05).There was no significant difference in the complications among the three groups(P>0.05).The developing rate of conventional dose group and low dose group was 76.2%(16.21)and 68.0%(17/25)respectively,there was no significant difference between the two groups[(χ^(2)=1.665,P=0.645),(χ^(2)=0.378,P=0.539)],there was no significant difference between the two groups in developing and neuronavigation concordance(χ^(2)=0.874,P=0.350).Conclusion:FLS of two doses(5 mg/kg,1 mg/kg)can achieve good fluorescence imaging effect in the operation of LGG.The application of FLS combined with neuronavigation can increase the total resection rate of tumor and improve the prognosis of patients.