Remebot 机器人辅助微创穿刺抽吸治疗原发性脑干出血的临床疗效分析

Clinical efficacy analysis of Remebot robot-assisted minimally invasive puncture aspiration in the treatment of primary brainstem hemorrhage

目的探讨机器人辅助穿刺抽吸治疗原发性脑干出血(PBSH)的安全性和可行性。方法回顾性分析2021年7月-2023年9月在山东第一医科大学第二附属医院接受机器人辅助穿刺抽吸治疗的11例PBSH患者临床资料,术后统计机械臂注册误差、手术时间、抽取出血量、残余血肿量、引流管时间及并发症发生情况;通过门诊或电话随访,询问患者生存状态,改良Rankin量表(mRS)评估神经功能恢复情况。结果患者出血部位均为桥脑,入院时格拉斯哥昏迷指数评分(GCS)为(3~9)分,平均(4.55±1.82)分;血肿量为(5.23~10.28)mL,平均(7.79±1.46)mL;机器人的机械臂注册误差为(0.06~0.10)mm,平均(0.08±0.01)mm;手术时间为(50~97)min,平均(67.00±13.10)min;术后残余血肿(1.2~6.3)mL,平均(3.41±1.70)mL;术后影像学证实引流管头端均位于血肿腔中央,无穿刺道出血或手术相关感染。11例患者中术后30 d内存活7例,死亡4例;术后90 d mRS评分:5分5例,4分2例。结论机器人辅助穿刺抽吸治疗PBSH安全可行,为精准治疗PBSH提供新思路。

Objective To investigate the safety and feasibility of robot-assisted puncture and aspiration for primary brainstem hemorrhage(PBSH).Methods The clinical data of 11 PBSH patients who received robot-assisted puncture and aspiration treatment in The Second Affiliated Hospital of Shandong First Medical University between July 2021 and September 2023 were analyzed retrospectively.Robotic arm registration error,the operative time,evacuated blood volume,the residual hematoma volume,timing of drains and occurrence of complicaions were statisticed after operation.Patient s survival status were inquired by outpatient visit or telephone follow-up.The modified Rankin scale(mRS)score was used to assess neurological recovery.Results The hemorrhage site of all patients was pontine.The Glasgow coma score(GCS)at admission was 3 to 9,mean score(4.55±1.82).The volume of hematoma ranged from 5.23 to 10.28 mL,mean volume(7.79±1.46)mL.The registration error of the robot arm was 0.06 to 0.10 mm(mean volume 0.08±0.01 mm).The operative time was 50 to 97 min(mean 67.00±13.10 min).The residual hematoma of postoperative was 1.2 to 6.3 mL(mean 3.41±1.70 mL).Postoperative imaging confirmed that the tip of all drainage tubes were located in the center of the hematoma cavity.None of the patients had puncture bleeding or surgery-related infection.Among the 11 patients,7 were survived within 30 days and 4 died.The postoperative mRS score after 90 days were 5 points in 5 cases and 4 points in 2 cases.Conclusions Robot-assisted puncture and aspiration for PBSH is safe and feasible,providing a new idea for precise treatment of PBSH.