發(fā)布時間：2018-06-02 22:45

  本文選題：顱腦膠質瘤 + 術中超聲　； 參考：《新疆醫(yī)科大學》2014年碩士論文

【摘要】：目的：探討術中超聲造影在顱腦膠質瘤手術中的臨床應用。方法：66例經CT或MRI疑似膠質瘤患者(最終經病理證實收集61例),切除前經知情同意告知患者超聲造影益處及風險并自愿選擇術中進行超聲造影檢查的患者(實驗組)及不愿或不能進行超聲造影檢查的患者(對照組)。術者手持探頭,觀察腫瘤二維超聲基本特征；超聲造影檢查在行常規(guī)超聲后,觀察腫瘤超聲造影特征；術后定期采用MRI進行判定兩組治療效果,對兩種情況下腦膠質瘤切除殘留率以及24月內腫瘤復發(fā)率進行對照研究,并按照膠質瘤級別分層后分析兩組殘留率、復發(fā)率是否存在差異。結果：(1)二維超聲顯示低、高級別的膠質瘤的邊界、形態(tài)、壞死有統(tǒng)計學差異(P0.05)。二維超聲上低、高級別膠質瘤的瘤周水腫無統(tǒng)計學差異(P0.05),而超聲造影兩者具有統(tǒng)計學差異(P0.05)。高級別膠質瘤的造影達峰時間早于低級別膠質瘤,組間比較有統(tǒng)計學差異(P0.05)。(2)膠質瘤術后定期檢查MRI,實驗組與對照組總體殘留率及高級別膠質瘤殘留率比較均有統(tǒng)計學意義(χ2=7.289,P0.05；χ2=5.903,P=0.015)；而低級別膠質瘤殘留率比較無統(tǒng)計學差異(χ2=0.873,P0.05)。術后隨訪24月內實驗組及對照組的總體及低級別膠質瘤復發(fā)率比較無統(tǒng)計學差異(χ2=3.755,P0.05；χ2=0.006,P=0.939),高級別膠質瘤復發(fā)率比較有統(tǒng)計學差異(χ2=4.521,P0.05)。結論：(1)術中常規(guī)超聲及超聲造影聯合應用,不同級別的膠質瘤具有不同的聲像圖特征,為膠質瘤手術過程中初步判斷膠質瘤級別提供較為客觀的診斷依據。(2)術中超聲造影指導膠質瘤手術具有常規(guī)超聲無法比擬的優(yōu)勢,尤其是對于高級別膠質瘤,可以顯著提高治療效果,降低腫瘤殘留率及復發(fā)率,能為膠質瘤切除術的療效判定提供客觀可靠的依據。
[Abstract]:Objective: to investigate the clinical application of intraoperative contrast-enhanced ultrasound in the operation of brain glioma. Methods Sixty-six patients suspected of glioma by CT or MRI (61 cases were confirmed by pathology, informed of the benefits and risks of contrast-enhanced ultrasound before resection and voluntarily selected for intraoperative contrast-enhanced examination) (experimental study) Group B) and patients who were unwilling or unable to perform contrast-enhanced ultrasonography (control group). The basic features of two-dimensional ultrasound were observed by using a probe held by the operator, the characteristics of ultrasound were observed after conventional ultrasound was performed, and MRI was used regularly after operation to determine the therapeutic effect of the two groups. The residual rate of glioma resection and the recurrence rate within 24 months were compared. The residual rate and recurrence rate of the two groups were analyzed according to the grade stratification of glioma. Results two dimensional ultrasound showed the boundary, morphology and necrosis of low and high grade gliomas (P 0.05). There was no significant difference in peritumoral edema between high grade gliomas and two dimensional ultrasonography (P 0.05), but there was a significant difference in contrast echocardiography between the two groups (P 0.05). The peak time of high grade gliomas was earlier than that of low grade gliomas. There was a statistical difference between the two groups (P 0.05). MRI was examined regularly after operation. There was significant difference between the experimental group and the control group in overall residual rate and high grade glioma residual rate (蠂 2 7. 289%, P 0. 05; 蠂 2 5. 903, P 0. 015, P 0. 015), but there was no significant difference in the residual rate of low grade glioma (蠂 2. 873%, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05). There was no significant difference in the overall and low grade glioma recurrence rates between the experimental group and the control group within 24 months of follow-up (蠂 2 + 3.755% P 0.05; 蠂 2 0. 006% P 0. 939). The recurrence rate of high grade gliomas was significantly different (蠂 2 4. 521% P 0 05). Conclusion conventional ultrasound and contrast-enhanced ultrasonography are used in combination with different grades of gliomas with different sonographic features. In order to provide a more objective diagnostic basis for the grade of gliomas during glioma surgery, intraoperative contrast-enhanced ultrasound has an incomparable advantage over conventional ultrasound in guiding glioma surgery, especially for high-grade gliomas. It can significantly improve the therapeutic effect, reduce the tumor residual rate and recurrence rate, and provide an objective and reliable basis for the evaluation of the curative effect of glioma resection.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1

【參考文獻】

相關期刊論文 前9條

1 牛朝詩,傅先明,姜曉峰,凌至培,魏祥品,魏建軍,汪業(yè)漢;神經導航系統(tǒng)在腦深部病灶手術中的應用[J];立體定向和功能性神經外科雜志;2005年01期

2 何文;姜笑千;張懋植;王碩;趙繼宗;劉會昭;;超聲技術在腦腫瘤術中的應用研究[J];中國超聲醫(yī)學雜志;2006年07期

3 趙玉珍;董超;劉紅磊;祝曉東;趙小華;王瑛;;肝臟良惡性腫瘤血流灌注的超聲造影定量評價[J];中國超聲醫(yī)學雜志;2007年05期

4 何文;姜笑千;王碩;張懋植;趙繼宗;劉會昭;;顱腦占位性病變的術中超聲應用研究[J];中華醫(yī)學超聲雜志(電子版);2006年02期

5 王立淑;何文;劉會昭;林松;田永吉;;術中超聲與病理評價顱腦膠質瘤切除程度的對照研究[J];中華醫(yī)學超聲雜志(電子版);2009年03期

6 賀焱;何文;張惠琴;;超聲造影在顱內血管性疾病中的應用[J];中華醫(yī)學超聲雜志(電子版);2010年03期

7 何文;姜笑千;王碩;張懋植;趙繼宗;劉會昭;;超聲造影在腦腫瘤術中的應用[J];中華超聲影像學雜志;2006年10期

8 張忠;江濤;謝堅;;術中實時超聲在腦功能區(qū)膠質瘤手術中的應用價值[J];中國微侵襲神經外科雜志;2007年11期

9 黃山;張義;;術中超聲在膠質瘤切除術中的應用[J];中國微侵襲神經外科雜志;2008年01期

，

本文編號：1970475