本文關(guān)鍵詞： 惡性膠質(zhì)瘤 熒光素鈉 全切率 無進(jìn)展生存期　出處：《吉林大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：神經(jīng)膠質(zhì)瘤是最常見的原發(fā)性惡性腦瘤，有很大的幾率出現(xiàn)不良的預(yù)后。高級別膠質(zhì)瘤的患者1年和2年生存率只有53.7%和14.6%，顯示了在最近幾年高級別膠質(zhì)瘤的患者越來越多，并且因?yàn)槠潆y治性，發(fā)病率，復(fù)發(fā)率，死亡率高和低治愈率的特性，大多數(shù)患者有非常差的預(yù)后。惡性膠質(zhì)瘤的治療依然是神經(jīng)外科學(xué)者所面臨的難題。現(xiàn)在腦膠質(zhì)瘤普遍采用手術(shù)治療，放療，化療等綜合治療方案。臨床研究表明外科手術(shù)切除仍然被認(rèn)為是膠質(zhì)瘤治療的第一方案，并且被認(rèn)為是影響膠質(zhì)瘤患者預(yù)后及生存的最重要因素。但是，由于腫瘤的侵襲性生長的生物學(xué)行為使得術(shù)中難以確定腫瘤和正常腦組織的界限，從而使完全切除這些腫瘤更加難以實(shí)現(xiàn)，因此，如何在手術(shù)過程中可以更加直觀地確定腫瘤組織，盡最大可能切除腫瘤是手術(shù)的關(guān)鍵所在。熒光素鈉引導(dǎo)新技術(shù)在膠質(zhì)瘤切除術(shù)中應(yīng)用，，可以顯著提高腫瘤全切率，改善患者無進(jìn)展生存期預(yù)后。 目的： 本研究的目的是為了評估熒光素鈉引導(dǎo)腦膠質(zhì)瘤切除的臨床效用。 方法： 在此我們將2011年7月至2013年7月收入我科的經(jīng)術(shù)前核磁共振診斷為膠質(zhì)瘤患者60例隨機(jī)分組。30例膠質(zhì)瘤患者在術(shù)中行熒光素鈉引導(dǎo)腫瘤切除術(shù)，并根據(jù)腫瘤組織的熒光素鈉染色強(qiáng)度（暗黃色，淺黃色，無染色）判斷腫瘤邊界并以此為依據(jù)切除腫瘤。30例膠質(zhì)瘤患者是根據(jù)術(shù)者經(jīng)驗(yàn)常規(guī)顯微操作切除腫瘤。計(jì)數(shù)資料、計(jì)量資料分別采用X2檢驗(yàn)，t檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析，比較兩組患者的全切率、KPS評分、手術(shù)時(shí)間及住院時(shí)間。 結(jié)果： 1、熒光素鈉引導(dǎo)手術(shù)組術(shù)中腫瘤切除病理與術(shù)后影像學(xué)回顧切除腫瘤程度一致。熒光引導(dǎo)手術(shù)組與傳統(tǒng)手術(shù)組術(shù)后復(fù)查CT或MRI提示熒光引導(dǎo)組患者腫瘤的切除更完全。 2、熒光素鈉組膠質(zhì)瘤全切26例（86.7%），傳統(tǒng)組手術(shù)全切17例（56.7%），兩組全切率的差異有顯著性（P0.05）；在非功能區(qū)兩組全切率差異有統(tǒng)計(jì)學(xué)顯著性（P0.05）。 3、在功能區(qū)上，熒光素鈉引導(dǎo)組術(shù)前術(shù)后KPS評分差異有顯著性（P0.05），而常規(guī)手術(shù)組差異無顯著性（P0.05）。 結(jié)論： 1、熒光素鈉引導(dǎo)新技術(shù)可顯著提高腦惡性膠質(zhì)瘤的全切率。 2、對于膠質(zhì)瘤位于功能區(qū)的患者，我們結(jié)合神經(jīng)電生理監(jiān)測，可顯著提高患者術(shù)后KPS評分。 3、術(shù)后結(jié)合替莫唑胺化療及放療可明顯延長患者無進(jìn)展生存期。 4、我們不推薦低級別膠質(zhì)瘤使用熒光素鈉作為術(shù)中熒光引導(dǎo)。
[Abstract]:Gliomas are the most common primary malignant brain tumors, with a high risk of poor prognosis. The 1-year and 2-year survival rates for high-grade gliomas are only 53.7% and 14.6, indicating a growing number of high-grade gliomas in recent years. And because of its refractory, morbidity, relapse rate, high mortality rate and low cure rate, Most patients have a very poor prognosis. The treatment of malignant gliomas is still a problem for neurosurgeons. Clinical studies show that surgical resection is still considered the first treatment for glioma and is considered to be the most important factor affecting the prognosis and survival of glioma patients. Because the biological behavior of aggressive growth of tumors makes it difficult to determine the boundaries between tumors and normal brain tissue during the operation, thus making complete excision of these tumors more difficult to achieve, How to determine tumor tissue more intuitively and remove tumor as far as possible is the key to the operation. The application of new technique guided by fluorescein sodium in glioma resection can significantly improve the total removal rate of the tumor. To improve the prognosis of progression-free survival. Objective:. The aim of this study was to evaluate the clinical efficacy of sodium fluorescein in glioma resection. Methods:. From July 2011 to July 2013, 60 patients with glioma diagnosed by preoperative MRI were randomly divided into three groups. 30 gliomas were treated with sodium fluorescein guided tumor resection during operation. According to the intensity of fluorescein sodium staining (dark yellow, light yellow, no staining) in tumor tissue, the tumor boundary was determined and the tumor was resected in 30 patients with glioma according to the experience of operation. The data were statistically analyzed by X _ 2 test and t test, and the KPS score, operation time and hospitalization time were compared between the two groups. Results:. 1. The degree of tumor resection during operation was the same as that in imaging review. Ct or MRI showed that the resection of tumor was more complete in fluorescence guided operation group and traditional operation group. 2. In the sodium fluorescein group, there were 26 cases of glioma with total resection and 17 cases of traditional group with total resection rate of 56.7%. There was a significant difference in the rate of total resection between the two groups (P 0.05), and the difference between the two groups in non-functional areas was statistically significant (P 0.05). 3. In the functional area, there was a significant difference in KPS score between the two groups before and after operation, but there was no significant difference between the conventional operation group and the routine operation group. Conclusion:. 1. The new technique of sodium fluorescein guidance can significantly improve the total removal rate of malignant gliomas. 2. For the patients with gliomas located in the functional area, we can significantly improve the postoperative KPS score in combination with electrophysiologic monitoring. 3, postoperative combined with temozolidomide chemotherapy and radiotherapy can significantly prolong the progression-free survival of patients. 4. We do not recommend the use of sodium fluorescein for intraoperative fluorescence guidance in low-grade gliomas.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.41

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