移动式床旁CT-CereTom在导航引导下锁孔手术治疗幕上高血压脑出血中的应用

APPLICATIONS OF PORTABLE BEDSIDE CT-CERETOM KEYHOLE SURGERY IN THE TREATMENT OF SCREEN HYPERTENSIVE CEREBRAL HEMORRHAGE ON NAVIGATION GUIDANCE

目的 探讨移动式床旁CT（Portable Bedside CT,PBCT）-CereTom在导航引导下锁孔手术治疗幕上高血压脑出血（Supratentorial hypertensive intracerebral hemorrhage）中的临床应用及其价值。方法 56例幕上高血压脑出血患者,手术前使用PBCT-CereTom行CT导航扫描。19例为床旁CT检查,37例为常规CT检查。手术后行CT扫描,了解血肿清除效果。结果 用mRS、GCS以及术后6个月GOS评分：术前GCS平均9分（范围：3~15分）,mRS平均4分（范围：2~5分）;出院时GCS平均14分（范围0~15分）,mRS平均3分（范围0~6分）,与术前相比差异有统计学意义（P〈0.001）;术后6个月总体生存率：94.64%（53/56）。GOS评分：57.1%（GOS 4~5）恢复良好,28.57%（16/56）合并（GOS 3）重残,8.6%（GOS 2）植物生存,5.7%（GOS 1）死亡;影像学评价：血肿清除率96.9%（范围：77.9~99.4%）,血肿清除率〉90%的病例数52例（92.86%）。结论 PBCT-CereTom的导航可以快速实施,并可保证图像质量,其导航引导下的锁孔手术快速、精准、安全和有效;术后实时了解血肿清除程度、血肿腔渗血情况,并可连续追踪观察;特别适合于危重患者的床旁检查。

Objective To explore the effect of mobile bedside CT（Portable Bedside CT,PBCT）-CereTom guide navigation lock curtain hole surgery on hypertensive intracerebral hemorrhage（Supratentorial hypertensive intracerebral hemorrhage）and its value in clinical application.Methods Curtain on56 cases of hypertensive cerebral hemorrhage patients before surgery used the navigation PBCT-CereTom CT scan line.Among them,19 cases were of bedside CT,37 cases were of conventional CT.After surgery,a CT scan was performed to understand the effect of hematoma.Results With mRS,GCS and GOS score after 6months：The average preoperative GCS was 9 points（range：3-15 points）,mRS average of 4 minutes（range：2-5 points）;GCS at discharge an average of 14 points（range 0-15 points）,mRS an average of3 points（range 0~6 points）,the difference was statistically significant（P〈0.001）compared with preoperative;The overall survival rate after 6 months was 94.64%（53/56）.GOS score was 57.1%（GOS 4~5）good recovery,28.57%（16/56）combined（GOS 3）severe disability,8.6%（GOS 2）plant survival,5.7%（GOS 1）death;Imaging evaluation：Hematoma rate：96.9%（range：77.9~99.4%）,hematoma rate90% of cases：52（92.86%）.Conclusions PBCT-CereTom navigation can be implemented quickly and ensure image quality,keyhole surgery under the guidance of its navigation fast,accurate,safe and effective;Real-time understanding of the extent of postoperative hematoma,hematoma cavity oozing,continuous follow-up observation;especially suitable for bedside testing of critically ill patients.