CAJ | 학술논문

目的研究囊性星形细胞瘤囊壁的术前影像学表现与术后病理学分析的相符合率，为外科手术提供理论支持。方法对北京天坛医院23例行显微神经外科手术治疗的囊性星形细胞瘤患者进行前瞻性研究，术前每一例患者均行增强MRI或CT检查，术中将每一例肿瘤囊壁的标本送透射电镜病理诊断，用以观察影像学上增强的瘤壁在电镜下是否有肿瘤细胞浸润，并与其病理学类型加以对比分析。结果15例患者MRI或CT显示囊壁强化的星形细胞瘤囊壁均有肿瘤细胞浸润，8例MRI或CT显示囊壁未强化的星形细胞瘤囊壁中，3例被肿瘤浸润。结论术前MRI显示囊壁强化的星形细胞瘤应予以全切，而囊壁未见强化肿瘤囊壁，术中应送快速冰冻检查，如无肿瘤细胞浸润，则只切除肿瘤结节，反之连囊壁全部切除。既防止遗漏病灶，又将手术剥离囊壁的人为损伤减小到最低，使神经外科手术操作更符合个体化、微创化的治疗原则。
목적연구낭성성형세포류낭벽적술전영상학표현여술후병이학분석적상부합솔，위외과수술제공이론지지。방법대북경천단의원23례행현미신경외과수술치료적낭성성형세포류환자진행전첨성연구，술전매일례환자균행증강MRI혹CT검사，술중장매일례종류낭벽적표본송투사전경병리진단，용이관찰영상학상증강적류벽재전경하시부유종류세포침윤，병여기병이학류형가이대비분석。결과15례환자MRI혹CT현시낭벽강화적성형세포류낭벽균유종류세포침윤，8례MRI혹CT현시낭벽미강화적성형세포류낭벽중，3례피종류침윤。결론술전MRI현시낭벽강화적성형세포류응여이전절，이낭벽미견강화종류낭벽，술중응송쾌속빙동검사，여무종류세포침윤，칙지절제종류결절，반지련낭벽전부절제。기방지유루병조，우장수술박리낭벽적인위손상감소도최저，사신경외과수술조작경부합개체화、미창화적치료원칙。
Objective To discuss the imaging features and pathological findings of cystic astrocytoma , to correlate it with its ultrastructure to analyze the surgical implications .Methods A retrospective analysis of 23 patients with cystic astrocytoma was performed with microneurosurgical method in Beijing Tiantan hospital . Preoperative every patient was performed magnetic resonance imaging with contrast enhancement and postoperative every tumor sample of living body were examined with transmission electron microscopy .To find the internal relation of the infiltrating tumor cells and capsulewall of enhancement .Results We found tumor cell infiltrating capsulewall with transmission electron microscopy in 15 cases with contrast enhancement before operation .There were 8 cases that capsulewall imaging with no contrast enhancement before operation , we found 3 cases of tumor cell infilitrating capsulewall .Conclusions We suggest that capsulewall of CAC imaging with no contrast enhancement need pick up“doubtful parts”in the capsulewall for frozen section examination in operation to direct the operation ′s method.If the result is tumor cell infiltrating the capsule ,wu should remove the whole capsulewall .if not,we can only remove the tumor nodus.Capsulewall of CAC imaging with contrast enhancement ,we think the whole capsule should remove in the operation.We try to cut down to the minimum of the operational injury of stripping the capsulewall of the cystic astrocytoma,that is to say,our operative procedures should follow to the microinvasive principle of neurosurgery .