目的: 探讨功能区脑胶质瘤手术中应用术中唤醒结合个体化定位技术的意义。方法: 对18 例功能
区脑胶质瘤病人使用核磁定位肿瘤、功能核磁定位功能区，导航确定入路，超声实时确定肿瘤边界、血运及切除
程度，唤醒病人，直接电刺激定位病灶附近的功能区。比较手术前后病人重要神经功能评分。结果: 18 例病人
均成功施行喉罩全麻术中唤醒，4 例病人出现短暂血压和心率改变，应用血管活性药物处理后好转; 2 例病人唤
醒后轻微烦躁，安抚后合作; 1 例病人病灶对侧手抽后肢体偏瘫。12 例肿瘤得到全切，5 例大部切除，1 例部分切
除。术后出现单侧肢体瘫痪2 例，运动性失语2 例，经过术后对症治疗，均好转出院，无颅内感染及死亡病例。
所有病人无手术痛苦回忆。手术前后重要神经功能评分对比无统计学差异。结论: 术中唤醒结合个体化定位技
术，有利于临近肿瘤功能区脑皮质和皮层下重要神经纤维束保护下，肿瘤最大程度切除，同时避免神经功能损
伤，改善预后。

Objective: To explore the application value and significance of intraoperative wake
combined with individual localization technique in the operation of brain function area． Method:
Nuclear magnetic and functional magnetic resonance imaging were used to locate， intraoperative neural
navigation was used to determine the surgical approach， real－time ultrasound was used to determinate
the tumor boundary，blood flow and removal of the patient; direct electric stimulation was used to locate
the functional area near the lesion in 18 cases of brain functional area glioma patients．Preoperative and
postoperative neurological function scores of patients were compared．Result: 18 patients were success-
fully treated with laryngeal mask airway general anesthesia－intraoperative wake－general anesthesia again．
A short of blood pressure and heart rate changes were improved in 4 patients after the application
of vasoactive drugs． 2cases of the slight irritability calmly cooperated after wake up． 1patients were
treated with mild limb movement disorder after awakening．Total tumor resection was achieved in 12 cases，
subtotal removal in 5 cases，partial resection in 1 cases．Unilateral limb paralysis occurred in 2 cases，
2cases of motor aphasia after surgery，all were improved and discharged after symptomatic treatment，
no intracranial infection and death cases． No significant difference of neurological function
between the preoperative and postoperative． Individual localization technique in the operation of the
functional area can be used to spreaded．Conclusion: The cerebral cortex and important nerve fiber
bundles can be protected，postoperative complications reduced， the prognosis of patients improved by
intraoperative wake combined with individual positioning technology．

R739．41

 收稿日期: 2016－11－04; 修回日期: 2016－12－11
基金项目: 内蒙古医科大学附属医院一般科研项目( 2014NYFY ZD) ;
内蒙古医科大学大学生科技创新“英才培育”项目( 2015YCPY043) ;
内蒙古医科大学附属医院重大项目( 2010NYFY ZD)
作者简介: 田复明( 1974－) ，男，内蒙古医科大学附属医院神经外科主任医师，医学博士。
通讯作者: 窦长武，主任医师，医学硕士，E－mail: douchangwu@ sina．com 内蒙古医科大学附属医院， 010050