机器人辅助颅内病变活组织检查术在高龄患者中的临床应用

The clinical application of robot-assisted intracranial lesion biopsy in elderly patients

目的探讨机器人辅助颅内病变穿刺活组织检查术在高龄患者中的临床应用。方法回顾性分析2019年3月至2021年3月北京大学第三医院神经外科采用机器人辅助颅内病变活组织检查术的30例高龄患者(72~93岁)的临床资料。术后均行病理学检查,同时评估机器人的手术精度,包括导航精度和穿刺精度。采用多重线性回归法判断影响穿刺精度的临床因素。结果30例患者的穿刺针均一次性置入目标病变,且针尖均位于病变组织内。术后1例患者出现靶区渗血(血肿体积<10ml);1例出现癫痫发作。30例患者均获得病理学检查,其中24例为肿瘤性病变,包括淋巴瘤10例转移癌6例神经上皮来源肿瘤5例、生殖细胞瘤3例;另6例为非肿瘤性病变,包括非特异性炎性反应4例、多发性硬化和脱髓鞘病变各1例。30例患者的机器人导航精度为(0.4±0.2)mm(0.1~0.7 mm),穿刺精度为(1.0±0.2)mm(0.6~1.3 mm),且导航精度高于穿刺精度(t=-11.64,P<0.01)。多重线性回归分析结果显示,性别、年龄及是否肿瘤性病变均对穿刺精度无影响(均P>0.05),而是否存在广泛脑萎缩是影响穿刺精度的临床因素(t=-2.52,P<0.05)。结论对高龄颅内病变患者行机器人辅助的活组织检查术,其术后并发症少,穿刺精度高,但伴有广泛脑萎缩时会影响穿刺精度。

Objective To explore the clinical application of robot-assisted intracranial lesion biopsy in elderly patients.Methods A retrospective analysis was conducted on the clinical data of 30 elderly patients(72-93 years old)who underwent robot-assisted intracranial lesion biopsy at the Department of Neurosurgery,Peking University Third Hospital from March 2019 to March 2021.Pathological examinations were performed after the operation,and the surgical accuracy of the robot was evaluated,including navigation accuracy errors and puncture accuracy errors.The multiple linear regression method was used to determine the clinical factors that affected the accuracy of puncture.Results The puncture needles of 30 patients were all inserted into the target lesion at one time,and the needle tips were all located in the lesion tissue.After the operation,1 patient developed bleeding in the target area(hematoma volume<10 ml);1 patient developed epileptic seizure.All 30 patients received pathological examinations,which revealed neoplastic lesions in 24 cases,including lymphomas in 10 cases,metastatic carcinomas in 6 cases,neuroepithelial tumors in 5 cases and germ cell tumors in 3 cases.The other 6 patients had non-neoplastic lesions,including 4 cases of non-specific inflammation,1 case of multiple sclerosis and 1 case of demyelinating disease.The robot navigation accuracy of 30 patients was 0.4±0.2 mm(0.1-0.7 mm),the puncture accuracy was 1.0±0.2 mm(0.6-1.3 mm),and the navigation accuracy was higher than the puncture accuracy(t=-11.64,P<0.01).The results of multiple linear regression analysis showed that gender,age,and whether the lesion was tumor or not had no effect on the puncture accuracy(all P>0.05),and whether there was extensive brain atrophy was the clinical factor that affected the puncture accuracy(t=-2.52,P<0.05).Conclusion Robot-assisted biopsy for elderly patients with intracranial lesions has few postoperative complications and high puncture accuracy,while it might affect the puncture accuracy when accompanied by extensive brain atrophy.