机器人辅助立体定向穿刺抽吸治疗脑干出血的疗效分析

Efficacy analysis of robot-assisted stereotactic aspiration in the treatment of brainstem hemorrhage

目的探讨机器人辅助立体定向穿刺抽吸技术治疗脑干出血的临床疗效。方法回顾性分析2019年12月至2021年12月天津市第一中心医院神经外科应用机器人辅助立体定向穿刺抽吸技术治疗脑干出血患者的临床资料,共40例。24例采用单靶点穿刺,16例采用双靶点穿刺;采用仰卧位经额入路12例、仰卧位经小脑幕下枕部入路20例、侧卧位经小脑幕下枕部入路8例。采用格拉斯哥预后分级(GOS)评估预后。所有患者均随访6个月。结果术后即刻头颅CT证实血肿大部分清除者7例(17.5%);术后尿激酶注入72 h内大部分清除者12例(30.0%),3~7 d大部分清除者14例(35.0%),1~4周内缓慢吸收者7例(17.5%)。所有患者均在术后7 d内拔除血肿腔引流管。术后4周内发生肺炎22例,低蛋白血症21例,应激性溃疡17例,深静脉血栓形成10例,肝、肾及心功能障碍15例。术后6个月,共死亡13例(32.5%)。存活的27例患者中,意识较术前改善者17例,其中完全清醒者5例,微意识状态12例;植物生存状态10例。GOSⅠ级13例,Ⅱ级10例,Ⅲ级12例,Ⅳ级5例。结论机器人辅助立体定向穿刺抽吸技术治疗脑干出血有助于提高脑干出血患者的生存率。

Objective To investigate the clinical effect of Rosa robot-assisted stereotactic aspiration in the treatment of brain stem hemorrhage.Methods The clinical data of 40 patients with brain stem hemorrhage treated by Rosa robot-assisted stereotaxic aspiration in the Neurosurgery Department of Tianjin First Central Hospital from December 2019 to December 2021 were retrospectively analyzed.Single-target puncture was performed in 24 cases and double-target puncture was performed in 16 cases.Transfrontal approach in supine position was used in 12 cases,subtentorial occipital approach in 20 cases and subtentorial occipital approach in 8 cases.Glasgow outcome scale(GOS)was used to evaluate the outcomes of patients.All patients were followed up for 6 months.Results Hematoma was cleared in 7 cases(17.5%)which was revealed by head CT immediately after operation.After urokinase injection,hematoma was mostly cleared within 72 h in 12 cases(30.0%),mostly cleared within 3-7 d in 14 cases(35.0%)and slowly absorbed within 1-4 week in 7 cases(17.5%).The drainage tube of hematoma cavity was removed in all patients within 7 days.There were 22 cases of pneumonia,21 cases of hypoproteinemia,17 cases of stress ulcer,10 cases of deep vein thrombosis,15 cases of liver,kidney and heart dysfunction.At 6 months post operation,13 patients(32.5%)died.Among the 27 patients who survived,17 patients had improved consciousness compared preoperative conditions,including 5 patients who were fully awake and 12 patients who showed minimally conscious state(MCS).There were 10 cases of vegetative state.GOS included 13 cases of gradeⅠ,10 cases of gradeⅡ,12 cases of gradeⅢ,and 5 cases of gradeⅣ.Conclusion Rosa robot-assisted stereotactic aspiration can improve the survival rate of patients with brain stem hemorrhage.