简易可视定位技术辅助神经内镜微创清除幕上高血压脑出血的疗效分析

Efficacy analysis on simple visual positioning technology used in minimally invasive removal of hypertensive cerebral hemorrhage by neuroendoscopy

目的探讨简易可视定位技术辅助神经内镜微创清除幕上高血压脑出血的可行性及临床疗效。方法回顾性分析61例幕上高血压脑出血手术治疗患者的临床资料。依据患者手术方式分为内镜组(37例)与显微手术组(24例)。术前将内镜组患者的DICOM格式CT数据用3D-Slicer软件行颅脑及血肿的三维重建,获取血肿体积、定位等参数,辅助血肿定位及手术路径设计,术中指导引入神经内镜直视下清除血肿并止血。显微手术组患者依据术前CT检查行血肿定位,常规开颅,皮层造瘘或侧裂入路清除血肿并止血。两组患者术后复查CT,计算残留血肿量。对两组患者的术前准备时间、手术时间、血肿清除率、术中出血量、术前和术后1周的格拉斯哥昏迷量表(GCS)及6个月后改良Rankin量表(mRS)评分进行比较。结果内镜组患者术中在简易可视定位技术辅助下穿刺器及工作鞘均达到预定的位置。内镜组与显微手术组患者年龄、性别、手术前后血肿量、手术前后GCS评分的差异无统计意义(均P>0.05)。内镜组患者术前准备时间[(24.30±5.3)min]与显微手术组[(23.20±5.8)min]的差异无统计意义(P>0.05)。内镜组患者的手术时间[(61.0±11.5)min]及术中出血量[(46.5±10.5)mL]均比显微手术组[(91.5±23.5)min,(103.5±13.5)mL]显著减少(均P<0.01)。内镜组患者术后6个月mRS评分(2.89±1.51)较显微手术组(3.68±1.52)明显改善(P<0.05)。两组均无术后再出血病例。结论基于3D-Slicer软件的简易可视定位技术未增加幕上高血压脑出血手术的术前准备时间,具有操作简单、便捷、可靠的特点,适用于急诊高血压脑出血患者的术前准备计划。其联合神经内镜能缩短手术时间、减少术中出血量,改善患者的预后,有较强的可行性及较好的临床疗效。

Objective To investigate the feasibility and clinical efficacy of minimally invasive removal of supratentorial hypertensive intracerebral hemorrhage by neuroendoscope assisted by simple visual positioning technology.Methods The clinical data of 61 patients with supratentorial hypertensive intracerebral hemorrhage were analyzed retrospectively.They were divided into endoscopic group(n=37)and microsurgery group(n=24)according to the operation methods.In the endoscopic group,CT data in DICOM format were obtained before operation,and 3D-Slicer software was used for 3D visualization reconstruction of brain and hematoma to obtain hematoma volume,location and other parameters,which assisted hematoma location and operation design.Intraoperative guidance was introduced to remove hematoma and haemostasis under neuroendoscope.In the microsurgery group,the hematoma was located by preoperative CT,and the hematoma was removed and stopped by routine craniotomy,cortical fistulation or lateral fissure approach.Both groups were reexamined brain CT after operation,and the volume of residual hematoma was calculated.The preoperative preparation time,operation time,hematoma clearance rate,intraoperative blood loss,Glasgow coma scale(GCS)before and 1 week after operation and modified Rankin scale(MRS)after 6 months were compared between the two groups.Results In the endoscopy group,the puncture device and working sheath reached the predetermined position with the help of simple visual positioning technology.There was no significant difference in age,gender,hematoma volume and GCS score between endoscopic group and microsurgery group.There was no significant difference in preoperative preparation time between endoscopy group(24.30±5.3)min and microscope group(23.20±5.8)min.The operation time and intraoperative blood loss in endoscopic group were(61.0±11.5)min and(46.5±10.5)mL respectively,which were significantly less than those in microsurgery group(91.5±23.5)min and(103.5±13.5)mL respectively(all P<0.01).The mRS score of endoscopic group(2.89±1.51)was significantly better than that of microscope group(3.68±1.52)(P<0.05).There was no postoperative rebleeding in both groups.Conclusions The simple visual positioning technology based on 3D-Slicer software does not increase the preoperative preparation time of patients with supratentorial hypertensive intracerebral hemorrhage.It has the characteristics of simple operation,convenience and reliability,and is suitable for the preoperative preparation plan of emergency patients with hypertensive intracerebral hemorrhage.The combination of neuroendoscopy and neuroendoscopy can shorten the operation time,reduce intraoperative bleeding and improve the prognosis of patients,which has strong feasibility and good effect,and is worthy of promotion.