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目的探讨弥散张量成像(DTI)对指导手术切除基底节区胶质瘤及降低致残率的临床意义。方法收集2009~2014年间我科收治的48例基底节区胶质瘤患者,术前行MRI+DTI,用纤维束示踪方法重建出锥体束,明确肿瘤和锥体束的三维空间结构关系,以避开锥体束设计手术入路,按纤维束受肿瘤侵袭程度指导手术切除肿瘤范围,术后评估神经功能状况。同时选取同期30例基底节区胶质瘤未行DTI的手术患者作为对照组,了解两者两组全切率及术后4周KPS评分的差异。结果对照组镜下全切19例,次全切7例,部分切除4例,全切率63.3%;DTI组镜下全切29例,次全切13例,部分切除6例,镜下全切率60.4%,两组镜下全切率比较,P>0.05,差别无统计学差异;对照组KPS评分为77.67±19.09分;DTI组KPS评分为87.29±14.84分,两组KPS评分比较,P<0.05,差别有统计学意义。结论术前DTI检查对指导手术切除基底节区胶质瘤有重要临床意义,起到降低患者致残率和提高术后生存质量的作用,但无提高肿瘤全切率。
Objective To investigate the clinical significance of diffusion tensor imaging (DTI) in guiding the removal of basal ganglia glioma and reducing the morbidity. Methods Forty-eight patients with basal ganglia glioma who were treated in our department from 2009 to 2014 were enrolled in this study. MRI + DTI was performed preoperatively, and pyramidal tract was reconstructed by fiber tracing method. The three-dimensional spatial structure of tumor and pyramidal tract was clarified , To avoid the pyramidal tract design of surgical approach, according to the extent of tumor invasion by the fiber bundle to guide the surgical excision of the tumor range, postoperative assessment of neurological status. At the same time, 30 patients with basal ganglia gliomas who did not undergo DTI in the same period were selected as the control group, and the differences between the two groups in total resection rate and KPS score at 4 weeks after operation were analyzed. Results In the control group, 19 cases underwent microsurgical resection, 7 cases were subtotectomy, 4 cases were partial resection and 63.3% cases were complete resection. Thirty-nine cases underwent microsurgical resection under microscope, 13 cases underwent subtotal resection and 6 cases underwent partial resection. The cut rate was 60.4%. There was no significant difference between the two groups (P> 0.05). The KPS score of the control group was 77.67 ± 19.09 and the KPS score of the DTI group was 87.29 ± 14.84. Comparing the KPS scores of the two groups, P <0.05, the difference was statistically significant. Conclusion Preoperative DTI examination has important clinical significance in guiding the surgical resection of basal ganglia gliomas, which can reduce the morbidity and improve the postoperative quality of life, but does not improve the rate of tumor resection.