Hong J, Chen B D, Yao X, Yang Y S
Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin 300350, China.
Zhonghua Wai Ke Za Zhi. 2018 Aug 1;56(8):611-616. doi: 10.3760/cma.j.issn.0529-5815.2018.08.012.
To investigate the clinic effect of the sodium fluorescein-guided microsurgical resection of glioblastoma. In a retrospective clinical study, 82 patients with glioblastoma confirmed by post-operative pathologic inspection in the Department of Neurosurgery of Tianjin Huanhu Hospital from January 2016 to June 2017 were randomly divided into sodium fluorescein (FL) group (42 cases) and traditional microsurgical (TM) group (40 cases). The tumors were removed by the sodium fluorescein-guided surgical procedure in the FL group. The tissues which displayed different intensity of fluorescent staining were taken for the pathologic inspection. The resection of tumors were completed under common microscope in the TM group. The two groups of patients underwent MRI enhanced scan at 48 hours after operation to determine the degree of tumor resection. The rate of gross total resection, postoperative complication, recurrent rate of two groups were compared by χ(2) test or Fisher exact test. Totally 135 fluorescent staining samples were obtained in the FL group. Forty-two samples were showed strong fluorescent staining, and all samples were proved to be tumor tissue by pathologic inspection, the sensitivity of FL was 100%. Thirty-seven gliomas were detected from 45 samples of faintly fluorescent staining, sensitivity of FL was 82.3%. Eight gliomas were found from 48 samples of non-fluorescent staining, the specificity of FL was 83.3%. The total resection rate of sodium fluorescein group was 85.7% (36/42), higher than that of traditional microsurgical group (62.5% (25/40)) (χ(2)=5.795, =0.016). Two groups of patients were followed up to 6 months after the operation, and 6 cases (14.3%, 6/42) were recurred in the FL group. Among them, 1 case died and the average Karnofsky performance score was 82.2±15.2. There were 12 recurrent cases (33.3%, 12/36) in the TM group, of which 2 cases were died and the average Karnofsky performance score was 76.9±20.3. There was significantly statistical difference in recurrent rate (χ(2)=3.962, =0.047). The sensitivity and specificity of fluorescein staining in glioblastoma tissue are high. And the application of sodium fluorescein-guided microsurgical resection of glioblastoma is safe and simple. Therefore, it is helpful to improve the total resection rate of glioblastoma patients and reduce the recurrence rate.
探讨荧光素钠引导下胶质母细胞瘤显微手术切除的临床效果。在一项回顾性临床研究中，将2016年1月至2017年6月在天津环湖医院神经外科经术后病理检查确诊的82例胶质母细胞瘤患者随机分为荧光素钠（FL）组（42例）和传统显微手术（TM）组（40例）。FL组采用荧光素钠引导下的手术方法切除肿瘤，取荧光染色强度不同的组织进行病理检查。TM组在普通显微镜下完成肿瘤切除。两组患者术后48小时行MRI增强扫描以确定肿瘤切除程度。采用χ²检验或Fisher确切概率法比较两组的全切除率、术后并发症、复发率。FL组共获得135份荧光染色样本。42份样本呈强荧光染色，经病理检查均证实为肿瘤组织，FL的敏感度为100%。45份弱荧光染色样本中检测出37例胶质瘤，FL的敏感度为82.3%。48份无荧光染色样本中发现8例胶质瘤，FL的特异度为83.3%。荧光素钠组全切除率为85.7%（36/42），高于传统显微手术组（62.5%（25/40））（χ²=5.795，P=0.016）。两组患者术后随访至6个月，FL组有6例（14.3%，6/42）复发，其中1例死亡，Karnofsky评分平均为82.2±15.2。TM组有12例复发（33.3%，12/36），其中2例死亡，Karnofsky评分平均为76.9±20.3。复发率差异有统计学意义（χ²=3.962，P=0.047）。荧光素染色在胶质母细胞瘤组织中的敏感度和特异度较高。荧光素钠引导下胶质母细胞瘤显微手术切除应用安全、简便，有助于提高胶质母细胞瘤患者的全切除率，降低复发率。
