3D-Slicer软件辅助定位微创血肿穿刺引流术在高血压基底节区出血中的应用

3D-slicer software assisted localization for minimally invasive puncture and drainage in the treatment of hypertensive basal ganglia hemorrhage

目的将3D-Slicer软件应用于高血压基底节区脑出血患者的血肿清除术中,探讨本病手术治疗的优化方案。方法选择邯郸市中心医院2018年9月至2019年9月收治的高血压脑出血患者178例,按照随机数字表法分为观察组86例和对照组92例,两组均采取微创血肿穿刺抽吸术并术后引流,观察组采取术前3D-Slicer辅助定位,对照组采取CT检查定位法。比较两组穿刺部位准确性、血肿清除率、拔管时间、手术时间、术后并发症、手术预后。结果观察组引流管置管准确率、术后第3天时血肿清除率均高于对照组,手术时间、引流管拔管时间短于对照组,差异有统计学意义(P<0.01)。观察组并发症总发生率显著低于对照组,差异有统计学意义(8.14%vs 27.17%,χ^(2)=10.921,P<0.01)。术后3个月,两组NIHSS评分均低于术前,且观察组低于对照组,差异有统计学意义(P<0.01)。术后3个月,观察组ADL分级优于对照组,差异有统计学意义(P<0.01)。结论3D-Slicer为高血压基底节区脑出血手术提供精确的穿刺部位,对提高血肿清除效率,改善手术预后具有积极意义。

Objective To explore the application value of 3 D-Slicer software in evacuation of hypertensive intracerebral hematomas in basal ganglia region.Methods A total of 178 patients with hypertensive intracerebral hemorrhage in basal ganglia region in the Handan Cetral Hospital from September 2018 to September 2019 were randomly divided into observation group(n=86)and control group(n=92).Before minimally invasive puncture and drainage was conducted in both groups,3 D-Slicer assisted localization was used in observation group,and localization with CT guidance was used in control group.The accuracy of puncture site,hematoma clearance rate,extubation time,operation time,postoperative complications and prognosis were compared between two groups.Results The accuracy rate of puncture site and hematoma clearance rate of 3 days after operation in observation group were significantly higher than those in control group,and the operation time and the time of extubation were shorter than those in control group(all P<0.01).The total incidence of complications in observation group was significantly lower than that in control group(8.14%vs 27.17%,χ^(2)=10.921,P<0.01).At three months after operation,National Institutes of Health Stroke Scale(NIHSS)were lower than those before operation in two groups and was significantly lower in observation group than that in control group(P<0.01).Activities of daily living(ADL)grading in observation group was superior to that in control group(P<0.01).Conclusion 3 D-Slicer assisted localization can provide more accurate puncture position for hypertensive intracerebral hemorrhage in basal ganglia region and can improve hematoma clearance rate and prognosis of the patients.