摘要
目的研究岛叶胶质瘤手术中3.0T磁共振实时影像功能导航联合术中神经电生理监测技术的应用效果。方法采用回顾性分析方法,选取2020年10月起中南大学湘雅医学院附属海口医院收治的岛叶胶质瘤患者40例为研究对象,均接受神经电生理联合导航技术辅助显微手术治疗,将其设定为A组;选取2018年1月至2019年12月收治的岛叶胶质瘤患者40例为研究对象,均于神经电生理监测与术中彩超辅助下行显微手术治疗,将其设定为B组;同时选取2018年1月以前收治的岛叶胶质瘤患者40例为研究对象,均接受常规开颅切除术治疗,将其设定为C组。比较3组患者手术时间、住院时间,术前、术后6个月时简易精神状态检查表(MMSE)评分,术前与术后7 d血清微小RNA(miR)-195、miR-375及神经元特异性烯醇化酶(NSE)水平,手术切除效果(全切、次全切、大部切除)及并发症(感染、失语、偏瘫)发生率。结果A、B组患者手术时间、住院时间分别为(85.14±5.43)min、(10.23±1.75)d,(87.38±6.06)min、(10.48±1.87)d,较C组[(106.82±8.41)min、(12.05±1.92)d]更短,差异均有统计学意义(P<0.05)。A、B组术后6个月MMSE评分分别为(24.57±3.85)、(24.24±3.63)分,水平较C组[(18.01±2.27)分]更高,差异均有统计学意义(P<0.05)。A、B组患者术后7 d血清miR-195、miR-375水平分别为0.85±0.12、0.75±0.14和0.82±0.11、0.72±0.13,较C组(0.67±0.09、0.58±0.12)更高,而NSR水平分别为(17.86±4.32)、(18.09±4.27)ng/mL,较C组[(24.91±2.68)ng/mL]更低,差异均有统计学意义(P<0.05)。A、B组患者手术全切率为70.00%、65.00%,较C组(22.50%)更高,差异有统计学意义(P<0.05)。A、B组患者并发症发生率为5.00%、7.50%,明显低于C组(27.50%),差异均有统计学意义(P<0.05)。A、B组上述指标均差异无统计学意义(P>0.05)。结论与常规开颅切除术相比,岛叶胶质瘤手术中3.0T术中磁共振实时影像功能导航联合术中神经电生理监测技术的应用效果显著,可改善患者认知功能与血清miR-195、miR-375、NSE水平,且手术时间短,可进一步提升手术全切率,减少并发症,促进患者快速康复。
Objective To study the application effect of 3.0T intraoperative real-time magnetic resonance imaging functional navigation combined with intraoperative electrophysiological monitoring for insular glioma.Methods The retrospective analysis methods was used,40 patients with insular glioma admitted to Haikou Hospital of Xiangya Medical College of Central South University from October 2020 were selected as the research objects.All patients received neuro-electrophysiological combined navigation technology-assisted microsurgery treatment and they were set as group A.Forty patients with insular glioma admitted from January 2018 to December 2019 were selected as the research objects,they were all treated by neuroelectrophysiological monitoring and intraoperative color Doppler ultrasound assisted microsurgery treatment and they were set as group B.At the same time,40 patients with insular glioma who were admitted before January 2018 were selected as the research objects,all of whom received conventional craniotomy treatment,and set them as group C.Compare the operation time,hospital stay,preoperative and 6 months postoperative mini-mental state examination(MMSE)scores,and simple mental state examination(MMSE)scores of the three groups of patients,preoperative and postoperative 7 days of serum microRNA(microRNA,miR)-195,miR-375 and neuron-specific enolase(NSE)levels,surgical resection effect(total resection,subtotal resection,subtotal resection)and Complications(infection,aphasia,hemiplegia)incidence.Results The operation time and hospitalization time of patients in groups A and B were(85.14±5.43)min,(10.23±1.75)d,and(87.38±6.06)min,(10.48±1.87)d,respectively,which were shorter than those in group C[(106.82±8.41)min,(12.05±1.92)d],the differences were statistically significant(P<0.05).The MMSE scores in group A and group B at 6 months after operation were(24.57±3.85)and(24.24±3.63)points respectively,which were higher than those in group C[(18.01±2.27)points],the differences were statistically significant(P<0.05).The levels of serum miR-195 and miR-375 in group A and group B at 7 days postoperatively were 0.85±0.12,0.75±0.14 and 0.82±0.11,0.72±0.13,respectively,which were higher than those in group C(0.67±0.09,0.58±0.12),and NSR levels were(17.86±4.32)and(18.09±4.27)ng/mL,which were lower than group C[(24.91±2.68)ng/mL],the differences were statistically significant(P<0.05).The total resection rates of patients in groups A and B were 70.00%and 65.00%,which were higher than those in group C(22.50%),the differences were statistically significant(P<0.05).The complication rates of patients in groups A and B were 5.00%and 7.50%,which were significantly lower than those in group C(27.50%),the differences were statistically significant(P<0.05).There was no statistically significant difference in the above indicators between groups A and B(P>0.05).Conclusion Compared with conventional craniotomy,3.0T intraoperative magnetic resonance real-time imaging functional navigation combined with intraoperative neuroelectrophysiological monitoring technology in insular glioma surgery has a significant application effect,which can improve the patient's cognitive function and serum miR-195,miR-375,NSE level,and short operation time,which can further increase the total surgical resection rate,reduce complications,and promote rapid recovery of patients.
作者
王小言
夏鹰
陈晓东
王青松
肖荣军
詹文亮
王婵
WANG Xiao-yan;XIA Ying;CHEN Xiao-dong(Department of Neurosurgery,Haikou Hospital Affiliated to Xiangya Medical College of Central South University,Haikou Haian 570208,China)
出处
《临床和实验医学杂志》
2021年第11期1223-1227,共5页
Journal of Clinical and Experimental Medicine
基金
海南省医药卫生科研项目(编号:20A200308)。
关键词
岛叶胶质瘤
3.0T磁共振实时影像功能导航
神经电生理监测
Neuroelectrophysiological monitoring
3.0T MRI real-time imaging function navigation
Neurophysiological monitoring
