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目的探讨术前、术后残留T2Flair体积对低级别胶质瘤预后的影响及相关因素分析。方法回顾性分析广东三九脑科医院2011年10月份至2015年9月病理确诊的47例WHO II级胶质瘤病例,所有病例采取了唤醒麻醉或非唤醒方式开颅切除肿瘤,术后均接受辅助放疗。收集患者术前、术后48小时内MRI-Flair图像,用Brainlab-i Plan软件定量计算术前及术后残余T2Flair体积。采用SPSS20.0统计软件进行生存分析,Kaplan-Meier法计算无进展生存率并行log-rank检验。结果 47例患者术前T2Flair中位体积80.01 ml(4.28~278.62 ml),术后残留T2Flair中位体积37.58ml(1.41~227.91 ml);中位随访时间37个月(18~65个月),7例失访,6例复发,2例死亡,5年无进展生存率80.2%;生存预后的单因素分析显示如下:年龄(<45岁与≥45岁)χ~2=0.026,P=0.873;病理类型(星形细胞瘤,少突胶质瘤,少突星形细胞瘤)χ~2=2.142,P=0.343;病变部位(额颞岛叶与非额颞岛叶)χ~2=4.069,P=0.044;术前体积(<46 ml与≥46 ml),χ~2=5.372,P=0.020;术后残留体积(<27 ml与≥27ml),χ~2=4.349,P=0.037。对术前体积≥46 ml的病例进一步分析,唤醒麻醉组T2Flair平均切除程度52.5%,全麻组T2Flair平均切除程度35.8%,P=0.035。结论 T2Flair术前体积及术后残留体积是影响低级别胶质瘤患者无进展生存时间的不良因素,唤醒麻醉可提高肿瘤T2Flair最大安全范围切除程度。
Objective To investigate the influence of preoperative and postoperative residual T2Flair volume on the prognosis of low grade gliomas and analyze the related factors. Methods A retrospective analysis of 47 cases of WHO grade II gliomas confirmed by pathological examination from March 2011 to September 2015 in SJTU of Guangdong Province was performed. All patients underwent craniotomy for arousal or non-arousal excision. All cases were followed up Receiving adjuvant radiotherapy. The MRI-Flair images were collected before and 48 hours after surgery. The volume of residual T2 Flair preoperatively and postoperatively was calculated using Brainlab-i Plan software. Survival analysis was performed using SPSS 20.0 statistical software. Kaplan-Meier method was used to calculate the progression-free survival rate and log-rank test. Results The median preoperative T2Flair volume was 80.01 ml (4.28 ~ 278.62 ml) and the residual volume of T2Flair was 37.58 ml (1.41 ~ 227.91 ml) in the 47 patients. The median follow - up time was 37 months (18-65 months) Seven patients were lost to follow-up, 6 patients relapsed and 2 patients died. The 5-year progression-free survival rate was 80.2%. The univariate analysis of survival prognosis showed as follows: age (45 years old and ≥ 45 years old) ; Pathological types (astrocytoma, oligodendroglioma, oligodendrocyte lesion) χ ~ 2 = 2.142, P = 0.343; lesion site (frontotemporal island and non-frontotemporal island) χ ~ 2 = 4.069, P = 0.044; χ ~ 2 = 5.372, P = 0.020; Preoperative volume (<46 ml and ≥46 ml) 0.037. The preoperative volume of ≥ 46 ml of further analysis, arousal anesthesia T2Flair average removal of 52.5%, T2Flair average degree of resection 35.8%, P = 0.035. Conclusions Preoperative volume of T2Flair and postoperative residual volume are the adverse factors that affect the progression-free survival time of patients with low-grade gliomas. Arousal anesthesia can improve the excision of the maximum safety range of T2Flair.