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目的:探讨功能磁共振成像(functional magnetic resonance imaging,f MRI)联合荧光素钠(fluorescein sodium,FLS)引导运动区胶质瘤手术治疗的临床应用价值。方法:将我院收治的45例运动区胶质瘤患者随机分组手术治疗。试验组(联合手术组,23例)术前行头颅f MRI检查,术中联合使用FLS治疗;对照组(传统手术组:22例)术前行头颅MRI辅查。术后3 d所有患者行MRI评估肿瘤全切率,术后2周使用Karnofsky评分评价患者术后生存质量。治疗结束后随访2年。观察两组患者在肿瘤切除程度、生存质量及术后2年生存率是否有统计学差别。结果:术后试验组患者中,肿瘤全切除比例为87%,而对照组仅为59.1%。试验组术后2周生存质量分级比例分别为非依赖级为91.3%、半依赖级为8.7%,无依赖级患者;对照组中非依赖级患者比例为45.5%、半依赖级为45.5%和依赖级为9%。实验组术后2年生存率为78.3%,对照组生存率为50%。试验组在肿瘤的全切率(P=0.037)、患者术后2周生存质量(P=0.001)和术后2年生存率(P=0.042)均高于传统手术组。结论:在运动区胶质瘤的手术治疗中,f MRI联合FLS能指导尽可能全切肿瘤组织,保护功能敏感区,显著提高患者生存质量,延长患者术后生存时间。
Objective: To investigate the clinical value of functional magnetic resonance imaging (f MRI) combined with fluorescein sodium (FLS) in guiding gliomas in motor zone. Methods: Forty-five patients with glioma in our hospital were randomly divided into operation group and operation group. In the experimental group (23 cases), cranial f MRI was performed preoperatively and combined with FLS. The control group (22 cases in the conventional surgery group) underwent craniocerebral MRI. Three days after operation, all patients underwent MRI to evaluate the tumor resection rate. Two weeks after surgery, the Karnofsky score was used to evaluate the postoperative quality of life. Follow-up 2 years after treatment. The two groups of patients were observed in the degree of tumor resection, quality of life and 2-year survival after surgery there is a statistically significant difference. Results: In the postoperative group, the total tumor removal rate was 87%, compared with 59.1% in the control group. The quality of life at 2 weeks after operation in the experimental group was 91.3% in the independent group and 8.7% in the semi-dependent group, respectively. The proportion of non-dependent patients was 45.5% in the control group and 45.5% in the semi-dependent group Dependency level is 9%. The postoperative 2-year survival rate was 78.3% in the experimental group and 50% in the control group. The total resection rate (P = 0.037), the quality of life 2 weeks after surgery (P = 0.001) and the 2-year survival rate (P = 0.042) in the experimental group were significantly higher than those in the conventional surgery group. Conclusion: In the surgical treatment of glioma in motor area, f MRI combined with FLS can guide the tumor resection as much as possible to protect functional sensitive areas, significantly improve patient quality of life and prolong postoperative survival time.