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山东大学学报（医学版） ›› 2017, Vol. 55 ›› Issue (11): 32-37.doi: 10.6040/j.issn.1671-7554.0.2017.036

• 临床医学 • 上一篇    下一篇

荧光素钠“黄荧光”导航辅助高级别胶质瘤手术治疗的临床意义

王超超,田海龙,姜慧峰,郭文强,王志刚   

  1. 山东大学齐鲁医院(青岛)神经外科, 山东 青岛 266000
  • 收稿日期:2017-01-11 出版日期:2017-11-10 发布日期:2017-11-10
  • 通讯作者: 王志刚. E-mail:wzg1110@126.com E-mail:wzg1110@126.com

Clinical significance of sodium fluorescein-guided resection of high-grade glioma under “yellow fluorescence” mode

WANG Chaochao, TIAN Hailong, JIANG Huifeng, GUO Wenqiang, WANG Zhigang   

  1. Department of Neurosurgery, Qilu Hospital of Shandong University(Qingdao), Qingdao 266000, Shandong, China
  • Received:2017-01-11 Online:2017-11-10 Published:2017-11-10

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摘要： 目的 探讨荧光素钠在“黄荧光”模式下辅助高级别胶质瘤手术治疗的临床意义。 方法 回顾性分析2014年1月至2015年12月山东大学齐鲁医院(青岛)神经外科收治并经病理确诊为高级别胶质瘤患者21例,全麻后经静脉注射荧光素钠,在“黄荧光”模式下进行肿瘤切除,术中比较肿瘤不同部位的荧光显影程度,选取多点病理送检,术后计算肿瘤全切率并分析各自病理,对患者进行长期术后随访。 结果 “黄荧光”下肿瘤与周围脑组织分辨良好,17例全切,4例次全切。肿瘤实质的荧光程度强于肿瘤边界及瘤周水肿(P<0.05)。同一患者不同部位肿瘤的病理结果不同,显微镜自然白光下判定为水肿的脑组织可检出肿瘤成分。 结论 荧光素钠“黄荧光”导航有助于识别肿瘤与脑组织的边界,利于肿瘤全切。高级别胶质瘤不同部位的荧光程度及病理结果可有不同。

关键词: 黄荧光, 高级别胶质瘤, 全切, 荧光素钠, 多点病理

Abstract: Objective To explore the clinical significance of sodium fluorescein-guided resection of high-grade glioma(HGG)under “yellow fluorescence” mode. Methods The clinical data of 21 HGG confirmed by pathological examination and treated during Jan. 2014 and Dec. 2015 were retrospectively analyzed. All patients underwent intravenous injection of sodium fluorescein after general anesthesia. Tumors were removed under “yellow fluorescence” mode. Fluorescence degree of different regions of tumor was compared and multiple site biopsy was implemented during the operation. Total resection rate was calculated and pathological results were analyzed after operation. All patients were followed up for a long term. Results “Yellow fluorescence” mode allowed a good discrimination between tumor and peripheral brain tissues. Total resection was achieved in 17 patients and subtotal resection in 4 patients. The core of tumor had a stronger fluorescence imaging compared to the boundary and the peritumoral edema(P<0.05). The pathological results differed in different regions of tumor in the same patient. Tumor cells could be detected in the peritumoral edema under traditional white light illumination. Conclusion Sodium fluorescein-guided surgery under “yellow fluorescence” mode helps to distinguish tumor and peripheral brain tissue as well as to facilitate total resection of gliomas. The fluorescence degree and pathological results differ in different regions of HGG.

Key words: Yellow fluorescence, Multiple site biopsy, Total resection, Sodium fluorescein, High-grade glioma

中图分类号: 

  • R651.1
[1] De Bonis P, Anile C, Pompucci A, et al. The influence of surgery on recurrence pattern of glioblastoma[J]. Clin Neurol Neurosurg, 2013, 115(1): 37-43.
[2] Orringer D, Lau D, Khatri S, et al. Extent of resection in patients with glioblastoma: limiting factors, perception of resectability, and effect on survival[J]. J Neurosurg, 2012, 117(5): 851-859.
[3] Stummer W, Meinel T, Ewelt C, et al. Prospective cohort study of radiotherapy with concomitant and adjuvant temozolomide chemotherapy for glioblastoma patients with no or minimal residual enhancing tumor load after surgery[J]. J Neurooncol, 2012, 108(1): 89-97.
[4] Acerbi F, Broggi M, Eoli M, et al. Fluorescein-guided surgery for grade IV gliomas with a dedicated filter on the surgical microscope: preliminary results in 12 cases[J]. Acta Neurochir(Wien), 2013, 155(7): 1277-1286.
[5] Acerbi F, Broggi M, Eoli M, et al. Is fluorescein-guided technique able to help in resection of high-grade gliomas?[J]. Neurosurg Focus, 2014, 36(2): 5.
[6] Schebesch KM, Hoehne J, Hohenberger C, et al. Fluorescein sodium-guided surgery in cerebral lymphoma[J]. Clin Neurol Neurosurg, 2015, 139(12): 125-128.
[7] Stummer W. Fluorescein in brain metastasis and glioma surgery[J]. Acta Neurochir(Wien), 2015, 157(12): 2199-2200.
[8] Chen B, Wang H, Ge P, et al. Gross total resection of glioma with the intraoperative fluorescence-guidance of fluorescein sodium[J]. Int J Med Sci, 2012, 9(8): 708-714.
[9] Shinoda J, Yano H, Yoshimura S, et al. Fluorescence-guided resection of glioblastoma multiforme by using high-dose fluorescein sodium. Technical note[J]. J Neurosurg, 2003, 99(3): 597-603.
[10] Schebesch KM, Brawanski A, Hohenberger C, et al. Fluorescein sodium-guided surgery of malignant brain tumors: history, current concepts, and future project[J]. Turk Neurosurg, 2016, 26(2): 185-194.
[11] Neira JA, Ung TH, Sims JS, et al. Aggressive resection at the infiltrative margins of glioblastoma facilitated by intraoperative fluorescein guidance[J]. J Neurosurg, 2016, 124(10): 1-12.
[12] Hamamcioglu MK, Akcakaya MO, Goker B, et al. The use of the YELLOW 560 nm surgical microscope filter for sodium fluorescein-guided resection of brain tumors: Our preliminary results in a series of 28 patients[J]. Clin Neurol Neurosurg, 2016, 143(4): 39-45.
[13] Davis LW. Malignant glioma-a nemesis which requires clinical and basic investigation in radiation oncology[J]. Int J Radiat Oncol Biol Phys, 1989, 16(6): 1355-1365.
[14] Stummer W, Stepp H, Moller G, et al. Technical principles for protoporphyrin-IX-fluorescence guided microsurgical resection of malignant glioma tissue[J]. Acta Neurochir(Wien), 1998, 140(10): 995-1000.
[15] Stummer W, Stocker S, Novotny A, et al. In vitro and in vivo porphyrin accumulation by C6 glioma cells after exposure to 5-aminolevulinic acid[J]. J Photochem Photobiol B, 1998, 45(2-3): 160-169.
[16] 赵世光, 陈晓丰, 滕雷, 等. 荧光示踪指导下高侵袭性胶质瘤的手术治疗[J]. 实用肿瘤杂志, 2014, 29(2): 111-114.
[17] Kuroiwa T, Kajimoto Y, Ohta T. Development of a fluorescein operative microscope for use during malignant glioma surgery: a technical note and preliminary report[J]. Surg Neurol, 1998, 50(1): 41-48, 48-49.
[18] 刘明, 刘楠, 刘晓亮, 等. 荧光素钠引导辅助下胶质瘤切除的应用[J]. 中国实验诊断学, 2015,19(2): 210-213. LIU Ming, LIU Nan, LIU Xiaoliang, et al. The application of fluorescein sodium guided to diagnose glioma border[J]. Chin J Lab Diagn, 2015, 19(2): 210-213.
[19] 田海龙, 何伟, 姜慧峰, 等. 荧光导航下切除胶质母细胞瘤及分子病理的表达意义[J]. 中国微侵袭神经外科杂志, 2016, 21(6): 254-257. TIAN Hailong, HE Wei, JIANG Huifeng, et al. Fluorescence-guided tumor resection and expressive significance of molecular pathology in glioblastoma[J]. Chin J Minim Invasive Neurosurg, 2016, 21(6): 254-257.
[20] 田海龙, 王益华, 郭振涛, 等. 荧光素钠导航下切除胶质母细胞瘤范围及分子病理学标志物表达的对比分析[J]. 生物医学工程与临床, 2016, 20(3): 251-256. TIAN Hailong, WANG Yihua, GUO Zhentao, et al. Comparative analysis on resection range of glioblastoma in navigation of fluorescein sodium and expression of molecular pathology markers[J]. BME & Clin Med, 2016, 20(3): 251-256.
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