多模态导航辅助可视化硬通道手术治疗高血压脑出血

Treatment of hypertensive cerebral hemorrhage using the visualization hard channel technology with the assistance of multimodal navigation

目的探讨多模态导航技术在内镜手术治疗高血压脑出血中的作用及优势。方法回顾性分析桂林医学院附属医院神经外科自2013年6月至2017年3月入院的75例高血压脑出血患者的临床资料,均采用神经内镜下经可视化硬通道手术方法清除颅内血肿,其中26例采用多模态导航技术(多模态导航组),29例采用CT导航技术(CT导航组),其余20例采用术中超声技术(术中超声组)。观察对比3组病例在手术时间、术中出血量、血肿清除率和术后并发症方面的差异,评价其疗效及预后。结果3组患者在手术时间和术中出血量方面差异无统计学意义(P>0.05);组间两两比较,多模态导航组在血肿清除率方面显著高于其余2组,差异具有统计学意义(P<0.05);在患者短期预后随访中,多模态导航组优于其余2组,但3组之间的差异无统计学意义(P>0.05)。结论多模态导航技术既可以保证透明鞘管准确穿刺到血肿腔内,还能够有效地实时显示残余血肿的位置。最终达到在高效率清除颅内血肿的同时尽量减少脑组织损伤的目的,使高血压脑出血患者的治愈率有所提高,值得在临床推广。

Objective To explore the role and advantages of multimodal navigation in endoscopic surgery for hypertensive intracerebral hemorrhage.Methods A retrospective research about 75 cases of hypertensive intracerebral hemorrhage was carried out in the Affiliated Hospital of Guilin Medical University.All patients went under the clearance of intracranial hematoma using the method of endoscopic visualization hard passage surgery.Twent-six cases of them accepted the help of multimodal navigation technology(multimodal navigation group)and another 29 cases accepted the help of CT navigation technology(CT navigation group)and the rest of 20 cases accepted the help of intraoperative ultrasound technology(ultrasound group).The three groups were observed and compared in operation time,amount of bleeding,hematoma clearance rate,postoperative complications,curative effect and prognosis.Results The difference of the three groups was not statistically significant(P>0.05)in operation time and intraoperative bleeding.The multimodal navigation group was higher significantly than the other two groups in hematoma clearance rate in the comparison among groups,and the difference was statistically significant(P<0.05).The multimodal navigation group was better than the other two groups in the shor-term prognosis estimated through the follo-up of patients,but there was no significant difference between the three groups(P>0.05).Conclusion The multimodal navigation technology,which is worth of clinical application,can ensure transparent sheath puncture into the hematoma cavity,but also can display the location of residual hematoma effectively.