无框架立体定向机器人辅助手术治疗高血压脑出血(附183例报告)  

Clinical application of frameless stereotactic robotic system in the treatment of hypertensive cerebral hemorrhage:a report of 183 cases

作　　者：马献昆[1] 李建华[1] 田增民[2] 尹丰[2] 罗谊[1] 马轶杰[1] 卢葛明[3] 

机构地区：[1]新疆生产建设兵团医院神经外科,乌鲁木齐830002 [2]海军总医院神经外科 [3]北京大学首钢医院神经外科

出　　处：《解放军医学杂志》2009年第8期1002-1004,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨无框架立体定向机器人辅助手术系统在高血压脑出血治疗中的应用价值及高血压脑出血超早期治疗的疗效。方法2005年6月-2008年1月收治的高血压脑出血患者183例,按手术时间分为超早期组(发病6h内进行手术,n=70)、早期组(发病48h内进行手术,n=90)、延期手术组(发病48h后进行手术,n=23),均采用无框架立体定向机器人辅助手术。术后2个月对患者进行日常生活能力(ADL)评测,并比较3组的疗效。结果手术安全有效,无严重手术并发症。超早期组术后死亡8例(11.4%),ADL1～ADL353例(85.5%)。早期组死亡11例(12.2%),ADL1～ADL347例(59.5%)。延期手术组死亡1例(4.3%),ADL1～ADL313例(59.1%)。三组间死亡率差异无统计学意义(P>0.05),而ADL1～ADL3患者比例差异显著(P<0.05)。结论无框架立体定向机器人辅助手术系统定位准确、创伤小、操作方便快捷,可满足临床高血压脑出血救治的要求。超早期治疗高血压脑出血可明显提高临床疗效。Objective To evaluate the application value and the therapeutic effect of frameless stereotactic robotic system in the treatment of hypertensive cerebral hemorrhage. Methods One hundred and eighty-three patients with hypertensive cerebral hemorrhage, admitted from Jun. 2005 to Jan. 2008, were divided into 3 groups according to the time of surgical procedure after the onset： ultra-early group （within 6h, 70 cases）, early group （within 48h, 90 cases）, delay group （after 48h, 23 cases）. All of the patients underwent surgical procedures assisted with frameless stereotactic robotic system, and the outcomes were evaluated by activity daily living （ADL） at 2 months follow-up and the results were compared among the 3 groups. Results The surgical operations were successfully performed on all the patients with no serious complications. In ultra early group, 8 cases （11. 4%） died and other 53 cases （53/62, 85.5%） recovered to ADL1-ADL3. In early group, 11 cases （12. 20%） died and other 47 cases （47/79, 59. 5%） recovered to ADL1-ADL3. In delay group, 1 case died and other 13 cases （13/22, 59. 1%） recovered to ADL1-ADL3. No significant difference was found in mortality among the 3 groups, while the proportion of ADL1 ADL3 was significantly lower in ultra-early group than in early group （P=0. 005 7） and delay group （P=0. 008 6）. Conclusions The frameless stereotactic robotic system may provide an accurate localization, minimally invasive procedure, convenient and rapid operation, an meet the requirements of clinical treatment of hypertensive cerebral hemorrhage. Ultra-early treatment may obviously improve the therapeutic effects in patients with hypertensive cerebral hemorrhage .

关 键 词：放射外科手术 颅内出血 高血压性 神经外科手术 

分 类 号：R651.11[医药卫生—外科学]