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

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