机器人联合神经内镜经侧脑室手术治疗丘脑出血临床效果观察  

Clinical effect observation of robot combined with neuroendoscopy in the treatment of thalamic hemorrhage by lateral ventricles urgery

作　　者：汪峰 冯清林 冉住国 聂颖 WANG Feng;FENG Qinglin;RAN Zhuguo;NIE Ying(Department of Neurosurgery,Chongqing University Three Gorges Hospital,Chongqing 404000,China;Department of Emergency Medicine,Chongqing University Three Gorges Hospital,Chongqing 404000,China)

机构地区：[1]重庆大学附属三峡医院神经外科重庆404000 [2]重庆大学附属三峡医院急诊内科重庆404000

出　　处：《医药前沿》2024年第33期24-28,共5页Journal of Frontiers of Medicine

基　　金：重庆市万州区科卫联合医学科研项目(wzstc-kw2021022)。

摘　　要：目的:观察机器人联合神经内镜经侧脑室手术治疗丘脑出血的临床效果。方法:选取2021年1月—2023年11月重庆大学附属三峡医院神经外科重症监护病房收治169例丘脑出血患者,将其中单纯丘脑出血患者66例按手术方式不同分为机器人导航血肿穿刺引流术组(A1组,25例)、机器人联合内镜丘脑血肿清除术组(经血肿离皮层最近点造瘘)(A2组,20例)、机器人联合内镜经侧脑室丘脑血肿清除术组(A3组,21例)3组;将丘脑出血破入脑室患者103例按手术方式不同分为机器人导航脑室外引流术组(B_(1)组,32例)、机器人导航脑室外引流+丘脑血肿穿刺引流术组(B_(2)组,22例)、机器人导航脑室外引流+机器人联合内镜丘脑血肿清除术(经血肿离皮层最近点造瘘)组(B_(3)组,24例)、机器人导航脑室外引流+机器人联合内镜经侧脑室行脑室内及丘脑血肿清除术组(B_(4)组,25例)4组。比较各组血肿清除率、引流管留置时间、住院时间、术后7 d格拉斯哥昏迷量表(GCS)评分、术后并发症及术后6个月格拉斯哥预后量表(GOS)评分。结果:A3组血肿清除率和术后7 d GCS评分、术后6个月GOS评分高于A1组,丘脑血肿腔引流管留置时间和住院时间短于A1组;住院时间短于A2组,术后7 d GCS评分和术后6个月GOS评分高于A2组,差异有统计学意义(P<0.05)。A1组血肿清除率低于A2组,丘脑血肿腔引流管留置时间长于A2组,差异有统计学意义(P<0.05)。B_(4)组血肿清除率、术后7 d GCS评分和术后6个月GOS评分高于其他3组,脑室引流管留置时间、住院时间短于其他3组,丘脑血肿腔引流管留置时间短于B_(2)组,差异均有统计学意义(P<0.05)。结论:机器人联合神经内镜经侧脑室手术治疗丘脑出血效果优于其他传统手术方式,且能改善患者远期预后。Objective To observe the clinical effect of robot combined with neuroendoscopic lateral ventricle surgery in the treatment of thalamic hemorrhage.Methods From January 2021 to November 2023,a total of 169 patients with thalamic hemorrhage were admitted to the neurosurgery intensive care unit of the Chongqing University Three Gorges Hospital.Among them,66 patients with simple thalamic hemorrhage were divided into three groups according to different surgical methods:robot navigation hematoma puncture and drainage group(group A1,25 cases),robot combined with endoscopic thalamic hematoma removal group(fistulation through the nearest point of hematoma from cortex)(group A2,20 cases),robot combined with endoscopic thalamic hematoma removal group(group A3,21 cases).According to different surgical methods,103 patients with thalamic hemorrhage breaking into ventricles were divided into four groups:robot-guided external ventricular drainage group(group B_(1),32 cases),robot-guided external ventricular drainage+thalamic hematoma puncture and drainage group(group B_(2),22 cases),robot-guided external ventricular drainage+robot combined with endoscopic hematoma removal(fistulation through the nearest point of hematoma from cortex)group(group B_(3),24 cases),robot-guided external ventricular drainage+robot combined with endoscopic translateral ventricle and thalamic hematoma removal group(group B_(4),25 cases).Hematoma clearance rate,drainage tube placement time,hospitalization time,Glasgow Coma Scale(GCS)score at 7 days after operation,postoperative complications and Glasgow Outcome Scale(GOS)score at 6 months after operation were compared among the groups.Results The hematoma clearance rate,GCS score at 7 days after operation and GOS score at 6 month after operation in group A3 were higher than those in group A1,and the indwelling time of thalamic hematoma cavity drainage tube and hospitalization time were shorter than those in group A1.The hospitalization time was shorter than that in group A2,the GCS score at 7 days after o

关 键 词：机器人 神经内镜 经侧脑室手术 丘脑出血 

分 类 号：R743[医药卫生—神经病学与精神病学]