CAJ | 학술논문

目的：探讨磁共振弥散张量成像(DTI)技术辅助高级别胶质瘤导航术中的效果。方法回顾性分析2007年2月~2013年2月汕头大学医学院第一附属医院收治的56例高级别胶质瘤患者的临床资料，根据手术方法不同将其分为DTI组(26例)和对照组(30例)。所有患者手术均在显微镜下完成，DTI组院皮层切口根据术前DTI显示的肿瘤与功能传导束的关系，选择避开传导束的脑沟进入。对照组院选择距离肿瘤较近的脑沟内进入。观察DTI组患者胶质瘤不同部位DTI的平均弥散系数(MD)、部分各向异性指数(FA)。观察两组患者肿瘤切除率、术后神经功能损害情况。结果 DTI组患者肿瘤病灶区、灶周水肿区及正常白质区的MD值分别为(1.266依0.261)×10-9、(1.125依0.140)×10-9、(0.820依0.089)×10-9 mm2/s，与正常白质区的MD值比较，肿瘤病灶区、灶周水肿区均升高，差异均有统计学意义(均P<0.05)；DTI组患者肿瘤病灶区、灶周水肿区及正常白质区的FA值分别为(0.173依0.025)、(0.220依0.029)、(0.405依0.046)，两两比较差异均有统计学意义(均P<0.05)。 DTI组患者肿瘤全切率为92.3%(24/26)，对照组为80.0%(24/30)，两组比较差异无统计学意义(P=0.189)。 DTI组患者术后未见新发神经功能缺损，对照组患者有3例术后肌力减退加重，3例视力减退加重，两组神经功能损害发生率分别为0.0%、20.0%，两组比较差异有统计学意义(P=0.046)。结论 DTI技术可清晰地显示脑胶质瘤与周围脑白质纤维束的解剖关系，可区分高级别胶质瘤肿瘤病灶区、灶周水肿区及正常白质区，划定了肿瘤的界限。对选择适宜的手术途径，最大限度地切除肿瘤的同时保护了脑组织结构重要的功能区及传导束，从而对保障患者术后的生活质量、延长患者的生存期具有重要的临床意义。
목적：탐토자공진미산장량성상(DTI)기술보조고급별효질류도항술중적효과。방법회고성분석2007년2월~2013년2월산두대학의학원제일부속의원수치적56례고급별효질류환자적림상자료，근거수술방법불동장기분위DTI조(26례)화대조조(30례)。소유환자수술균재현미경하완성，DTI조원피층절구근거술전DTI현시적종류여공능전도속적관계，선택피개전도속적뇌구진입。대조조원선택거리종류교근적뇌구내진입。관찰DTI조환자효질류불동부위DTI적평균미산계수(MD)、부분각향이성지수(FA)。관찰량조환자종류절제솔、술후신경공능손해정황。결과 DTI조환자종류병조구、조주수종구급정상백질구적MD치분별위(1.266의0.261)×10-9、(1.125의0.140)×10-9、(0.820의0.089)×10-9 mm2/s，여정상백질구적MD치비교，종류병조구、조주수종구균승고，차이균유통계학의의(균P<0.05)；DTI조환자종류병조구、조주수종구급정상백질구적FA치분별위(0.173의0.025)、(0.220의0.029)、(0.405의0.046)，량량비교차이균유통계학의의(균P<0.05)。 DTI조환자종류전절솔위92.3%(24/26)，대조조위80.0%(24/30)，량조비교차이무통계학의의(P=0.189)。 DTI조환자술후미견신발신경공능결손，대조조환자유3례술후기력감퇴가중，3례시력감퇴가중，량조신경공능손해발생솔분별위0.0%、20.0%，량조비교차이유통계학의의(P=0.046)。결론 DTI기술가청석지현시뇌효질류여주위뇌백질섬유속적해부관계，가구분고급별효질류종류병조구、조주수종구급정상백질구，화정료종류적계한。대선택괄의적수술도경，최대한도지절제종류적동시보호료뇌조직결구중요적공능구급전도속，종이대보장환자술후적생활질량、연장환자적생존기구유중요적림상의의。
Objective To probe the effect of magnetic resonance diffusion tensor imaging technology in the high-grade gliomas navigation intraoperative. Methods The clinical data of 56 patients with high-grade glioma from February 2007 to February 2013 in the First Affiliated Hospital of Shantou University Medical College were analyzed retrospectively, and they were divided into two groups according to the different surgical methods, DTI group (26 cases) and control group (30 cases). All operations were performed under the microscope, DTI group:the skin incision was chosen to avoid tracts sulci according to the relationship between preoperative tumor DTI display and function tracts; control group:they were chosen from the trench into the brain tumor closer. The average diffusion coefficient (MD) and fractional anisotropy index (FA) in different parts of glioma DTI of patients in DTI group were observed. The rates of tumor resec-tion, postoperative nerve function damage of patients in two groups were observed. Results MD value of patients in the DTI group with high-grade glioma tumor lesions, perifocal edema and normal white matter areas were (1.266±0.261)í10-9, (1.125±0.140)í10-9, (0.820±0.089)í10-9 mm2/s respectively, compared with the normal white matter, the MD values of tumor lesions, perifocal edema were higher, the differences were statistically significant (all P<0.05); FA values of patients in the DTI group, perifocal edema and normal white matter area were (0.173±0.025 ), (0.220±0.029), (0.405±0.046) respectively, the differences were statistically significant (all P<0.05). The rate of total resection in the DTI group was 92.3% (24/26), and the control group was 80.0% (24/30), the difference was not statistically significant (P=0.189). There was no patients with new neurological deficit performance in the DTI group after surgery, but the muscle weakness of 3 cases were aggravated, and vision loss of 3 cases were increased after surgery in the control group, the incidence of nerve function damage in two groups were 0.0%and 20.0% respectively, the difference was sta-tistically significant (P=0.046). Conclusion DTI technology can clearly show the anatomical relationship with the sur-rounding glioma brain white matter fiber bundles, also can distinguish high-grade glioma tumor lesions, perifocal ede-ma and normal white matter, delineation of the tumor boundaries, provide a reasonable surgical approach for the sur-geon, maximize the removal of the tumor while protecting the brain structures important functional areas and tracts, and thus protecting the quality of life and prolong survival of patients has important clinical significance.