本文關(guān)鍵詞： 神經(jīng)導(dǎo)航 術(shù)中超聲 術(shù)中多點(diǎn)病理學(xué)報(bào)告 高級(jí)別膠質(zhì)瘤　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的探討神經(jīng)導(dǎo)航聯(lián)合術(shù)中超聲在高級(jí)別膠質(zhì)瘤切除手術(shù)中的作用和價(jià)值。方法(1)收集2014年1月至2016年10月我院20例術(shù)前擬診斷且術(shù)后病理學(xué)確診為高級(jí)別膠質(zhì)瘤的患者的臨床資料,20例惡性膠質(zhì)瘤患者中,女性8例,男性12例。最大年齡71歲,最小5歲。平均年齡43歲。(2)患者均術(shù)前使用MRI介導(dǎo)的神經(jīng)導(dǎo)航系統(tǒng)制定最佳的手術(shù)方案;打開(kāi)腦硬膜前應(yīng)用神經(jīng)導(dǎo)航定位腫瘤邊界,融合術(shù)中B超聲驗(yàn)證;術(shù)中應(yīng)用超聲及導(dǎo)航引導(dǎo)顯微鏡下切除腫瘤病變,實(shí)時(shí)術(shù)中超聲糾正導(dǎo)航圖像偏移并檢查切除腫瘤的體積;使用術(shù)中超聲、神經(jīng)導(dǎo)航下觀察選取的腫瘤影像學(xué)邊界多點(diǎn)術(shù)中病理學(xué)報(bào)告判斷病變切除的程度和范圍。(3)根據(jù)術(shù)后72小時(shí)增強(qiáng)MRI結(jié)果判斷患者腫瘤切除程度并隨訪患者術(shù)后恢復(fù)情況。結(jié)果經(jīng)導(dǎo)航系統(tǒng)有助于制定最優(yōu)化的手術(shù)治療方案,對(duì)病變定位準(zhǔn)確率為100%;神經(jīng)導(dǎo)航結(jié)合術(shù)中實(shí)時(shí)超聲能顯著提高腫瘤的全切除率及神經(jīng)功能保護(hù);術(shù)中超聲、神經(jīng)導(dǎo)航結(jié)合顯微鏡下觀察選取的腫瘤影像學(xué)邊界多點(diǎn)術(shù)中病理學(xué)檢查能較精確判定腫瘤的生物學(xué)邊界,提高切除范圍;在其指導(dǎo)下16例獲得全切除,4例獲得次全切除;術(shù)后無(wú)嚴(yán)重并發(fā)癥病例,無(wú)死亡病例。結(jié)論經(jīng)導(dǎo)航聯(lián)合術(shù)中超聲及在顯微鏡下觀察下選取腫瘤邊界多點(diǎn)術(shù)中病理指導(dǎo)顯微神經(jīng)外科手術(shù)能提高高級(jí)別膠質(zhì)瘤“安全最大化切除”率;為多模態(tài)技術(shù)下精準(zhǔn)手術(shù)治療提供臨床依據(jù);為術(shù)后的精準(zhǔn)適型放射治療及綜合治療提供良好的基礎(chǔ)。
[Abstract]:Objective to evaluate the role and value of neuronavigation combined with intraoperative ultrasound in the resection of high grade gliomas. From January 2014 to October 2016, the clinical data of 20 patients with high grade glioma were collected. Of the 20 patients with malignant glioma, 8 were female and 12 were male. The oldest age was 71 years. Patients with the youngest age of 5 years with an average age of 43 years were treated with MRI-mediated neuronavigation system before operation to make the best operation plan. Neuronavigation was used to locate the margin of the tumor before opening the dura dural, and B-mode ultrasound was used to verify the localization of the tumor. Intraoperative ultrasound and navigation guided microscope were used to remove tumor lesion, real-time ultrasound was used to correct the deviation of navigation image and the volume of tumor was examined. Use intraoperative ultrasound. Evaluation of the extent and extent of resection of lesions by intraoperative pathology report of selected tumor imaging boundary under neuronavigation. According to the results of enhanced MRI at 72 hours after operation, the degree of tumor resection was evaluated and the postoperative recovery was followed up. Results the navigation system was helpful to make the optimal surgical treatment. The accuracy of localization was 100%. Neuronavigation combined with intraoperative real-time ultrasound could significantly improve the rate of total resection and the protection of neural function. Intraoperative ultrasound, neuronavigation combined with microscope observation of tumor imaging boundary multi-point intraoperative pathological examination can more accurately determine the biological boundary of the tumor, improve the scope of resection; Under its guidance, 16 cases received total resection and 4 cases got subtotal resection. There were no serious complications after operation. Conclusion guided by navigation combined with intraoperative ultrasound and microscopically observed multiple points of tumor boundary, microneurosurgery can improve the rate of "safety maximization resection" of high grade gliomas. To provide the clinical basis for the precise surgical treatment under the multi-modal technology. It provides a good basis for accurate and comprehensive radiotherapy after operation.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R739.41

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