摘要
目的 探讨术中磁共振成像在脑胶质瘤手术治疗中的应用价值.方法 回顾性分析复旦大学附属华山医院神经外科2010年12月至2016年12月利用术中磁共振成像进行开颅手术的366例脑胶质瘤患者的临床资料.术后定期对所有患者行门诊随访,同时复查头颅MRI.采用Kaplan-Meier生存曲线描述脑胶质瘤患者的总生存期（OS）和无进展生存期（PFS）.进一步采用Logrank单因素和Cox多因素分析方法评价影响世界卫生组织（WHO）Ⅳ级脑胶质瘤患者预后的相关因素.结果 366例患者中,67.2％（246/366）达到肿瘤全切除.其中WHOⅣ级胶质瘤全切除率显著高于Ⅱ、Ⅲ级（分别为73.2％、58.5％、61.9％,均P＜0.05）,WHOⅡ、Ⅲ级患者肿瘤全切除率间的差异无统计学意义（P＞0.05）.所有患者中,90例（24.6％）在术中磁共振扫描后进行二次肿瘤切除,较首次的肿瘤切除程度显著提高（分别为95.9％、81.9％,P＜0.001）.统计学分析结果显示,WHOⅣ级女性脑胶质瘤患者的预后优于男性（P＜0.05）;高龄较低龄患者的复发风险更大,但是对于整体预后无明显影响（P＞0.05）;肿瘤位置对于患者预后影响不大（P＞0.05）;而肿瘤全切除是影响预后的独立危险因素,肿瘤全切除患者的预后优于非全切除者（P＜0.05）;术后放、化疗能够改善患者预后（P＜0.05）.结论 术中磁共振成像能显著提高脑胶质瘤的切除程度,并改善脑胶质瘤患者的预后.
Objective To summarize our experience of application of intraoperative magnetic resonance imaging （iMRI） in glioma surgery and to investigate its clinical efficiency.Methods A retrospective analysis was conducted to evaluate the extent of resection （EOR） and outcomes of 366 glioma patients who underwent craniotomy under guidance of iMRI from December 2010 to December 2016 at Department of Neurosurgery,Huashan Hospital,Fudan University.Regular follow-up and head MRI were performed for all patients.Overall survival （OS） and progression free survival （PFS） curves were analyzed by Kaplan-Meier method.Log-rank tests and Cox proportional hazards model were used for univariate and multivariate comparisons,respectively.Results A total of 366 glioma patients were enrolled into this study.The rate of gross total resection （GTR） was 67.2%.The GTR rate of glioblastoma multiform （GBM） （73.2%） was significantly higher than that of grade Ⅱ （58.5%,P 〈 0.05） or grade Ⅲ glioma （61.9%,P 〈 0.05）.There was no significant difference in the GTR rate between grade Ⅱ and grade Ⅲ gliomas（P 〉 0.05）.Following the initial iMRI scan,90 patients underwent further resection with a significant improvement of mean EOR from 81.9% to 95.9% （P 〈0.001）.Our results revealed that the gender,GTR and radio-chemotherapy were all independent prognostic risk factors in GBM patients.Age and location of tumor had no significant influence on the prognosis of GBM patients （all P 〉 0.05）.Conclusion The application of iMRI could efficiently increase the EOR of glioma surgery and improve the prognosis of glioma patients.
作者
吴帅
李泽阳
邱天明
庄冬晓
路俊锋
吴劲松
Wu Shuai;Li Zeyang;Qiu Tianming;Zhuang Dongxiao;Lu Junfeng;Wu Jinsong(Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, Chin)
出处
《中华神经外科杂志》
CSCD
北大核心
2018年第4期333-337,共5页
Chinese Journal of Neurosurgery
基金
国家“十二五”科技支撑计划（2014BAI04B01,2014BAI04B05）
上海市卫生计生系统优秀青年人才培养计划（2017YQ014）
关键词
神经胶质瘤
磁共振成像
神经外科手术
预后
Glioma
Magnetic resonance imaging
Neurosurgical procedures
Prognosis
