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目的探讨荧光引导切除人脑胶质瘤,肿瘤组织荧光特性与组织病理学特性的关系。方法对手术治疗的原发、复发恶性胶质瘤患者在手术中行5-ALA荧光引导下的肿瘤切除。术中使用荧光显微镜检测肿瘤荧光,荧光组织在安全许可的范围内被切除。术中取肿瘤组织的中心,周边和边缘位置的组织,行HE染色作组织病理学分析,比较各部位的组织学特点。利用免疫组化方法检测VEGF,CD31在不同荧光区域组织中的表达。计算并比较不同荧光部位组织的VEGF,CD31的阳性表达。结果在肿瘤的中心部位,荧光显示为鲜红色,肿瘤细胞密度高,肿瘤生长呈共生性,可见血管内皮细胞增生,局部区域有坏死,周边部弱红色的区域肿瘤密度低,肿瘤细胞多呈浸润性生长,少见血管内皮细胞增生。在边缘不发光区域观察到为正常脑组织。免疫组化结果提示VEGF,CD31的表达随荧光强度的降低呈下降趋势。结论荧光手术边界和病理学边界相符;组织的增殖活性以及血管生成特性与荧光强度呈正相关。
Objective To investigate the relationship between fluorescence characteristics and histopathological features of human gliomas induced by fluorescence guided excision. Methods Surgical resection of primary and recurrent malignant gliomas underwent surgery with 5-ALA fluorescence-guided tumor excision. Intraoperative fluorescence microscopy was used to detect tumor fluorescence, and fluorescent tissues were excised within safety clearances. Intraoperative tumor tissue at the center, peripheral and marginal tissue, HE staining for histopathological analysis, comparing the histological features of various parts. Immunohistochemistry was used to detect the expression of VEGF and CD31 in different fluorescent regions. Calculate and compare the positive expression of VEGF and CD31 in different fluorescent tissues. Results In the central part of the tumor, the fluorescence showed bright red, the tumor cell density was high, the tumor growth was symbiotic, the vascular endothelial cell hyperplasia was observed, the local area was necrotic, the peripheral weak red area had a low tumor density, Sexual growth, rare vascular endothelial cell proliferation. Normal brain tissue is observed at the non-glittering edges. The results of immunohistochemistry suggested that the expression of VEGF and CD31 decreased with the decrease of fluorescence intensity. Conclusions Fluorescent surgery is consistent with the pathological boundary. The proliferative activity and angiogenic properties are positively correlated with the fluorescence intensity.