【摘要】 目的研究荧光素钠(FLS)"黄荧光"染色引导手术切除胶质母细胞瘤(GBM)的作用,及其与临床因素的关系。方法回顾分析24例胶质母细胞瘤患者的临床资料,并对汉族与少数民族患者的临床资料进行比较。患者术中静脉注射荧光素钠染色,分别在肿瘤黄染边界及黄染边界外0.5 cm范围内的无黄染区域多点取材行病理检查,观察肿瘤细胞浸润程度,以确定肿瘤边界并引导手术切除肿瘤。对比术前、术后MRI增强扫描的肿瘤体积确定肿瘤切除程度。以术前、术后1周、术后1个月KPS评分评判患者的疗效。采用Spearman秩相关对肿瘤切除程度、瘤周无黄染区病理改变与临床因素的相关性进行分析。结果汉族与少数民族患者各临床资料比较,差异均无统计学意义。本组患者中,肿瘤黄染边界组织病理检查示,19例患者为胶质母细胞瘤,3例患者为胶质细胞增生,2例患者为间变星形细胞瘤;瘤周无黄染区组织病理检查示,22例患者为胶质细胞增生,2例患者为弥漫星形细胞瘤。肿瘤全切除者16例,次全切除者8例(肿瘤均涉及脑功能区、基底节区和脑室)。术后1个月与术前的KPS评分对比,好转17例,无变化3例,加重4例。肿瘤切除程度与肿瘤部位涉及基底节区核团和脑室呈负相关(r=-0.84,P <0.05);瘤周无黄染区组织病理改变与1P19Q呈负相关(r=-0.44,P <0.05)。结论荧光素钠"黄荧光"染色技术可在术中实时有效引导胶质母细胞瘤切除,提高切除率,改善患者预后;肿瘤切除程度与肿瘤部位,瘤周无黄染区病理改变与1P19Q相关。更多还原

【Abstract】 Objective To study the effect of fluorescein sodium(FLS) "yellow fluorescence"staining in guiding glioblastoma(GBM) surgery and its relationship with clinical factors.Methods The clinical data of 24 patients with GBM were analyzed retrospectively,and the clinical data of Han and minority patients were compared.The patients were intravenously injected with fluorescein sodium staining during the operation.The samples were taken from the yellow staining boundary and the non yellow staining area within 0.5 cm outside the yellow staining boundary for pathological examination.The degree of tumor cell infiltration was observed to determine the tumor boundary and guide the operation to remove the tumor.The tumor volume was compared to determine the extent of tumor resection before and after operation.KPS scores were evaluated before operation,1 week and 1 month after operation.Spearman rank correlation was used to analyze the correlation between the degree of tumor resection,pathological changes in the non yellow stained area around the tumor and clinical factors.Results There was no significant difference in clinical data between Han and minority patients.In this group of patients,histopathological examination of tumor yellow staining boundary showed that 19 patients were GBM,3 patients were microgliosis,2 were anaplastic astrocytoma.Histopathological examination of tumor without yellow staining area showed that 22 were GBM,2 patients were diffuse astrocytoma.The tumors were totally resected in 16 and subtotally resected in 8.One month after operation,compared with preoperative KPS score,17 were improved,3 were unchanged,and 4 were aggravated.There was a negative correlation between the degree of tumor resection and the location of tumor involving basal ganglia nuclei and ventricles(r =-0.84,P < 0.05).There was a negative correlation between the histopathological changes of no yellow staining area around tumor and 1P19Q(r =-0.44,P < 0.05).Conclusion FLS"yellow fluorescence"staining technology can effectively guide the resection of GBM in real time during operation,improve the resection rate and prognosis of patients.The degree of tumor resection is related to the tumor location,and the pathological changes of non yellow staining area around the tumor are related to 1P19Q.更多还原