基于术前MRI+3D slicer技术的显微镜下切除术对脑胶质瘤患者肿瘤标志物、神经功能及预后的影响

doi:10.19854/j.cnki.1008-2425.2024.05.0002

摘要/Abstract

摘要： 目的观察术前磁共振成像(MRI)结合3D slicer技术的显微镜下切除术在脑胶质瘤中的临床应用,并分析其对患者肿瘤标志物、神经功能及预后的影响。方法纳入103例2018年7月～2023年2月本院收治的脑胶质瘤患者进行研究,其中54例在术中以常规引导手术切除(对照组),余下49例采用术前MRI+3D slicer的显微镜下切除术(研究组),比较两组手术相关指标、肿瘤标志物[神经元特异性烯醇化酶(NSE)、血管内皮生长因子(VEGF)、糖类蛋白153(CA153)]、神经功能、并发症及预后情况。结果相比于对照组,研究组术中出血量明显较少(P＜0.05),下床活动时间明显较短(P＜0.05),研究组总全切率为87.76%,明显高于对照组(P＜0.05)。研究组NSE、VEGF、CA153水平明显低于对照组(P＜0.05)。术后两组不同时点的NIHSS评分有差异(P＜0.05),研究组与对照组相比NIHSS评分较低(P＜0.05),且两组NIHSS评分降低趋势有差异(P＜0.05)。两组术后并发症的总发生率无明显差异(P＞0.05)。相比对照组,随访12个月研究组肿瘤复发率明显较低(P＜0.05),而两组存活率则无明显差异(P＞0.05)。结论相对于常规切除术,术前MRI+3D slicer技术的显微镜下切除术方案能提高病灶的全切除率,降低NSE、VEGF、CA153水平和神经功能损伤,并有助于降低术后复发。

关键词: 脑胶质瘤, 磁共振成像, 神经功能, 肿瘤标志物

Abstract: Objective To observe the clinical application of microscopic resection based on preoperative magnetic resonance imaging (MRI) combined with 3D slicer technology in glioma,and to analyze its influence on tumor markers,neurological function and prognosis. Methods A total of 103 patients with glioma admitted to the hospital were included in the study from July 2018 to February 2023.54 cases were treated with conventional guided surgical resection (the control group),and the remaining 49 cases carried out preoperative MRI+3D slicer-based microscopic resection (the study group).The two groups were compared in terms of surgical related indicators,tumor markers[neuron-specific enolase (NSE),vascular endothelial growth factor (VEGF),carbohydrate protein 153 (CA153)],neurological function,complications and prognosis status. Results Compared with the control group,the intraoperative blood loss in the study group was significantly less (P＜0.05),and the ambulation time was significantly shorter (P＜0.05).The overall total resection rate in the study group (87.76%) was significantly higher than that in the control group (P＜0.05).The levels of NSE,VEGF and CA153 were significantly lower in the study group than those in the control group (P＜0.05).The NIHSS score was different between the two groups at different time points after surgery (P＜0.05).The NIHSS score was lower in the study group compared to the control group (P＜0.05),and the decrease trend of NIHSS score was different between both groups (P＜0.05).No significant difference was shown in the total incidence rate of postoperative complications between groups (P＞0.05).After 12 months of follow-up,compared with the control group,the study group had significantly lower tumor recurrence rate (P＜0.05),but there was no obvious difference in the survival rate between the two groups (P＞0.05). Conclusion Compared with conventional resection,preoperative MRI+3D slicer technology-based microscopic resection can improve the total resection rate of lesion,reduce the levels of NSE,VEGF and CA153 and neurological damage,and help to reduce postoperative recurrence.

Key words: Glioma, Magnetic resonance imaging, Neurological function, Tumor markers

中图分类号:

R739.41

王宜兵, 张磊, 陈建军, 常成, 宋国智. 基于术前MRI+3D slicer技术的显微镜下切除术对脑胶质瘤患者肿瘤标志物、神经功能及预后的影响[J]. 立体定向和功能性神经外科杂志, 2024, 37(5): 262-266.

Wang Yibing, Zhang Lei, Chen Jianjun, Chang Cheng, Song Guozhi. Influence of preoperative MRI+3D slicer technology-based microscopic resection on tumor markers,neurological function and prognosis in patients with glioma[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(5): 262-266.

参考文献

[1] Wang LM,Englander ZK,Miller ML,et al.Malignant Glioma[J].Adv Exp Med Biol,2023,1405:1~30.
[2] Tsitlakidis A,Aifantis EC,Kritis A,et al.Mechanical properties of human glioma[J].Neurol Res,2020,42(12):1018~1026.
[3] Silvani A.New perspectives:Glioma in adult patients[J].Tumori,2023,109(4):350~355.
[4] Rahman R.Toward the next generation of high-grade glioma clinical trials in the era of precision medicine[J].Cancer J,2021,27(5):410~415.
[5] Pradhan A,Mozaffari K,Ghodrati F,et al.Modern surgical management of incidental gliomas[J].J Neurooncol,2022,159(1):81~94.
[6] Bennett C,González M,Tapia G,et al.Cortical mapping in glioma surgery:correlation of fMRI and direct electrical stimulation with Human Connectome Project parcellations[J].Neurosurg Focus,2022,53(6):E2.
[7] 黄紫祎,王永恒.脑胶质瘤边界识别的成像技术研究进展[J].神经疾病与精神卫生,2022,22(12):837~841.
[8] Jin W,Fatehi M,Abhishek K,et al.Artificial intelligence in glioma imaging:challenges and advances[J].J Neural Eng,2020,17(2):021002.
[9] Hou XL,Xu RX,Chen LY,et al.3D color multimodality fusion imaging as an augmented reality educational and surgical planning tool for extracerebral tumors[J].Neurosurg Rev,2023,46(1):280.
[10] Xing Y,Lin N,Han R,et al.Sevoflurane versus PRopofol combined with Remifentanil anesthesia Impact on postoperative Neurologic function in supratentorial Gliomas (SPRING):protocol for a randomized controlled trial[J].BMC Anesthesiol,2020,20(1):117.
[11] Osuka S.Global trends in pre-clinical research on malignant glioma[J].No Shinkei Geka,2021,49(3):485~489.
[12] Bettag C,Hussein A,Behme D,et al.Endoscopic fluorescence-guided resection increases radicality in glioblastoma surgery[J].Oper Neurosurg,2020,18(1):41~46.
[13] 陈素华,杨军,陈新,等.多模态影像三维重建联合神经导航在功能区胶质瘤手术中的应用[J].中华神经外科杂志,2021,37(9):874~879.
[14] 闫新亭,宋双双,卢洁.磁共振扩散加权成像在脑胶质瘤的研究进展[J].医学影像学杂志,2021,31(9):1586~1589.
[15] 贤俊民,陈凤月,孙晓妍,等.3D Slicer三维重建技术在脑功能区肿瘤手术治疗中的应用价值[J].中国临床神经外科杂志,2022,27(10):819~821+824.
[16] 马龙涛,马绍玉.3D Slicer软件在神经外科手术中的临床应用[J].安徽医学,2023,44(11):1401~1405.
[17] Hou XL,Xu RX,Chen LY,et al.3D color multimodality fusion imaging as an augmented reality educational and surgical planning tool for extracerebral tumors[J].Neurosurg Rev,2023,46(1):280.
[18] 宋旭东,罗波,刘毅,等.3D-Slicer软件在鞍旁脑膜瘤手术规划中的运用[J].临床神经外科杂志,2022,19(3):258~261.
[19] 王伟,沈龙山,程雯,等.基于常规MRI的影像学特征联合MRS在脑胶质瘤术前分级评估及预测术后复发的应用研究[J].中国CT和MRI杂志,2023,21(7):15~18.