新型激光定位器结合导向器在颅脑手术中的应用体会暨“淤血半暗带”理论的猜想  

Experience of New Laser Locator Combined with Deflector in Localization of Craniocerebral Lesions and the Theoretical Conjecture of "Congestion Penumbra"

作　　者：张凌云 唐丹[2] ZHANG Ling-yun;TANG Dan(Hunan Provincial People's Hospital(The First Affiliated Hospital of Hunan Normal University),Changsha 410005,Hunan,China;Huaihua First People's Hospital,Huaihua 418099,Hunan,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)神经外科,湖南长沙410005 [2]怀化市第一人民医院神经外科,湖南怀化418099

出　　处：《中国现代手术学杂志》2021年第4期246-250,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的总结我科使用新型激光定位技术在脑出血、脑肿瘤、脑脓肿、脑活检等病种的应用情况,分析基底节区中小血肿采用新型激光定位技术进行精准微创治疗的初步效果,并提出颅内血肿周边存在“淤血半暗带”的理论猜想。方法回顾性分析2020年7月至2021年8月在湖南省人民医院神经外科接受手术的15例患者,均在术中应用新型激光定位技术进行精准定位。分析新技术的使用情况及体会,主要是定位的精准性和便捷性。结果所有病人均直接阅片后进行定位,未进行专门CT扫描,定位都达到术前规划要求,定位时间平均为12 min。其中基底节区中小血肿患者微创手术后短期内功能恢复速度明显,说明颅内血肿周边存在“淤血半暗带”的可能性。结论新型激光定位技术在精度、速度、易用度三方面结合良好,有助于提高脑部各类手术的安全性及效率。基底节区中小血肿患者神经功能的快速恢复,可能与出血后深静脉回流受阻导致的“淤血半暗带”因为手术得到缓解有关,值得进一步研究。Objective To summarize the application experience of a new laser positioning technology in surgery of cerebral hemorrhage,brain tumors,brain abscesses,brain biopsy and other brain diseases,and to analyze the preliminary results for precise and minimally invasive treatment of small and medium basal ganglia hematomas,and try to verify the theoretical conjecture of"congestion penumbra".Methods A retrospective analysis of 15 cases of operation performed in Hunan Provincial People's Hospital from July 2020 to August 2021,all of which were performed intraoperatively with new laser positioning technology for precise localization.The use and experience of the new technology was analyzed,mainly in the accuracy and convenience of localization.Results All patients were positioned directly after reading the CT film.No additional CT scan was needed.The positioning met the preoperative planning requirements,and positioning time was 12 minutes on average.Among them,patients with small and medium hematomas in the basal ganglia area recovered quickly and obviously after minimally invasive surgery,which may prompt the existence of the"congestion penumbra".Conclusion The new laser positioning technology has a good combination of accuracy,speed and ease of use,which helps to improve the safety and efficiency of various brain operations.The rapid recovery of nerve function in patients with small and medium hematomas in the basal ganglia may be related to the"congestion penumbra"caused by the obstruction of deep venous oppressed by hemorrhage,which can be eased by surgery,and it is worthy of further study.

关 键 词：新型激光定位技术 立体定向 微创手术 淤血半暗带 

分 类 号：R651.1[医药卫生—外科学]