中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2011年
8期
699-702
,共4页
周涛%孟祥辉%许百男%魏少波%陈晓雷%周定标%侯远征%肖炳祥%余光宏%王东
週濤%孟祥輝%許百男%魏少波%陳曉雷%週定標%侯遠徵%肖炳祥%餘光宏%王東
주도%맹상휘%허백남%위소파%진효뢰%주정표%후원정%초병상%여광굉%왕동
脊索瘤%磁共振成像%神经导航%经蝶手术%神经内镜
脊索瘤%磁共振成像%神經導航%經蝶手術%神經內鏡
척색류%자공진성상%신경도항%경접수술%신경내경
Chordoma%Magnetic resonance imaging%Neuronavigation%Transsphenoidal approach%Neuroendoscope
目的 总结高场强术中磁共振成像(iMRI)系统在内镜经口或经鼻脊索瘤手术中应用的初步经验.方法 自2009年1月至2010年12月,共有23例脊索瘤患者进行了内镜经口或鼻iMRI辅助下的手术.男性12例,女性11例,年龄29～64岁,平均(42±3)岁.肿瘤最大径2.0～5.7 cm,平均(3.5±0.8)cm.术中应用1.5 T移动磁体双室设计的iMRI系统,其中20例联合使用了神经导航系统.结果 23例内镜经口或鼻脊索瘤手术中,扫描次数1～5次,平均2.5次,20例应用了导航技术,12例根据术中扫描更新了导航的资料.15例iMRI扫描发现了肿瘤残留.其中12例进一步手术切除,并最终经iMRI扫描证实9例得到全切除,3例残留肿瘤得到进一步切除.肿瘤全切除率由34.8%(8/23)提高到73.9%(17/23).在15例术中扫描发现肿瘤残留的脊索瘤中,巨大脊索瘤占9例.巨大脊索瘤术中扫描残留检出率为9/11,其他脊索瘤术中扫描残留检出率为6/12.未发生与iMRI相关的并发症或安全事故.结论 高场强iMRI系统能够在术中获得高质量的影像,为手术中实时判断肿瘤切除程度提供了客观依据,提高了内镜经口或鼻脊索瘤的肿瘤切除程度和手术安全性.
目的 總結高場彊術中磁共振成像(iMRI)繫統在內鏡經口或經鼻脊索瘤手術中應用的初步經驗.方法 自2009年1月至2010年12月,共有23例脊索瘤患者進行瞭內鏡經口或鼻iMRI輔助下的手術.男性12例,女性11例,年齡29～64歲,平均(42±3)歲.腫瘤最大徑2.0～5.7 cm,平均(3.5±0.8)cm.術中應用1.5 T移動磁體雙室設計的iMRI繫統,其中20例聯閤使用瞭神經導航繫統.結果 23例內鏡經口或鼻脊索瘤手術中,掃描次數1～5次,平均2.5次,20例應用瞭導航技術,12例根據術中掃描更新瞭導航的資料.15例iMRI掃描髮現瞭腫瘤殘留.其中12例進一步手術切除,併最終經iMRI掃描證實9例得到全切除,3例殘留腫瘤得到進一步切除.腫瘤全切除率由34.8%(8/23)提高到73.9%(17/23).在15例術中掃描髮現腫瘤殘留的脊索瘤中,巨大脊索瘤佔9例.巨大脊索瘤術中掃描殘留檢齣率為9/11,其他脊索瘤術中掃描殘留檢齣率為6/12.未髮生與iMRI相關的併髮癥或安全事故.結論 高場彊iMRI繫統能夠在術中穫得高質量的影像,為手術中實時判斷腫瘤切除程度提供瞭客觀依據,提高瞭內鏡經口或鼻脊索瘤的腫瘤切除程度和手術安全性.
목적 총결고장강술중자공진성상(iMRI)계통재내경경구혹경비척색류수술중응용적초보경험.방법 자2009년1월지2010년12월,공유23례척색류환자진행료내경경구혹비iMRI보조하적수술.남성12례,녀성11례,년령29～64세,평균(42±3)세.종류최대경2.0～5.7 cm,평균(3.5±0.8)cm.술중응용1.5 T이동자체쌍실설계적iMRI계통,기중20례연합사용료신경도항계통.결과 23례내경경구혹비척색류수술중,소묘차수1～5차,평균2.5차,20례응용료도항기술,12례근거술중소묘경신료도항적자료.15례iMRI소묘발현료종류잔류.기중12례진일보수술절제,병최종경iMRI소묘증실9례득도전절제,3례잔류종류득도진일보절제.종류전절제솔유34.8%(8/23)제고도73.9%(17/23).재15례술중소묘발현종류잔류적척색류중,거대척색류점9례.거대척색류술중소묘잔류검출솔위9/11,기타척색류술중소묘잔류검출솔위6/12.미발생여iMRI상관적병발증혹안전사고.결론 고장강iMRI계통능구재술중획득고질량적영상,위수술중실시판단종류절제정도제공료객관의거,제고료내경경구혹비척색류적종류절제정도화수술안전성.
Objective To review the preliminary clinical experience with high-field-strength intraoperative magnetic resonance imaging (iMRI) in the endoscopic chordoma operation with transsphenoidal or transoral approach.Methods From Janury 2009 to December 2010, 23 patients [range, 29-64 years, mean age (42 ± 3) years] of chordoma were operated with endoscopic transsphenoidal or transoral approach and examined intraoperatively with a movable 1.5 T iMRI magnet.Tumor size range was 2.0-5.7 cm, mean (3.5 ±0.8)cm.A navigation system based on iMRI was used in 20 cases. Results iMRI scan were performed in each operation from 1 time to 5 times.Neuronavigation system were used in 20 operations and the data renewed in 12 cases by the information from iMRI.In 15 of 23 patients, iMRI had revealed residual lesions and resulted in 12 cases further treatment, eventually, 9 tumors were totally removed and 3 tumors were further removed.The ratio of total removal tumor was enhanced to 73.9% ( 17/23 ) from 34.8%(8/23).Among 15 cases of paitial chordoma removal detected by scanning in operation, 9 were huge chordoma The residual of huge chordoma detected by scanning in operation was 9/11, and other chordoma contributed to 6/12.There were no iMRI related safety issue or accident recorded in this study.Conclusions High-field-strength iMRI provids high-quality images of tumor resection that allows intraoperative modification of the surgical strategy.Combined with the navigation system, iMRI is helpful to maximize the resection of the chordoma and benefit for the safety of endoscopic operation.
