改良无框架立体定向手术治疗脑干出血的疗效观察  

Effect of improved frameless stereotactic surgery for the treatment of brainstem hemorrhage

作　　者：娄金峰[1] 杨璨宇 王在斌 姜帆 陶胜忠[1] 牛光明[1] LOU Jinfeng;YANG Canyu;WANG Zaibin;JIANG Fan;TAO Shengzhong;NIU Guangming(The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China;The First Clinical Medical College of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第二附属医院,河南郑州450003 [2]郑州大学第一临床医学院,河南郑州450052

出　　处：《中国实用神经疾病杂志》2025年第4期427-431,共5页Chinese Journal of Practical Nervous Diseases

基　　金：河南省科技攻关项目(编号:232102310279)。

摘　　要：目的探讨多模态影像融合与神经导航联合引导下无框架立体定向穿刺抽吸引流治疗脑干出血的效果。方法对2018-10—2023-10郑州大学第二附属医院神经外科运用多模态影像融合和神经导航引导的无框架立体定向精准穿刺抽吸引流技术治疗的35例脑干出血患者的临床数据进行回顾性研究。术后24 h复查头颅CT以判断脑干引流后的残余血肿量,同时依据残余血肿量决定是否注射尿激酶引流。手术前后进行GCS量表评估,术后30 d对所有患者进行随访,了解其存活状态,并对存活者进行mRS评估。结果35例患者手术均一次性穿刺成功,术中无死亡。术后24 h头颅CT复查显示,35例患者的颅内残余血肿量(3.8±1.2)mL,血肿清除率(61.3±26.4)%。术前GCS评分(6.9±3.1)分,术后(9.6±3.2)分,手术前后GCS评分存在统计学差异(P<0.05)。术后30 d随访,35例患者中30例存活,5例死亡,病死率14.3%,存活患者mRS评分(3.8±1.0)分。结论多模态影像融合与神经导航联合引导下无框架立体定向穿刺抽吸引流治疗脑干出血的疗效较好,能有效清除脑干血肿,解除血肿对脑干的压迫,避免继发性损伤,从而降低病死率及致残率,改善患者预后。Objective To investigate the effectiveness of frameless stereotactic puncture drainage guided by multimodal image fusion and neuronavigation in the treatment of brainstem hemorrhage.Methods A retrospective study was conducted on the clinical data of 35 patients with brainstem hemorrhage in the Neurosurgery Department of the Second Affiliated Hospital of Zhengzhou University from October 2018 to October 2023,using multimodal image fusion and neuronavigation guided frameless stereotactic precise puncture and suction drainage technology.Brain CT was reexamined 24 hours after the operation,which was to judge the amount of residual hematoma in brainstem,and whether to determine to inject urokinase drainage or not according to the amount of residual hematoma.GCS was performed before and after surgery.All the patients were followed up 30 days after the operation to understand their survival status,and mRS assessment was performed on survivors.Results All the 35 patients had successful puncture at one time,and there was no death during operation.Twenty-four hours after operation,the volume of residual intracranial hematoma in 35 patients was(3.8±1.2)mL,and the hematoma clearance rate was(61.3±26.4)%.The preoperative GCS score was(6.9±3.1)points,and the postoperative GCS score was(9.6±3.2)points,there was statistical difference in GCS score before and after operation(P<0.05).After 30 days of following-up,30 patients survived and 5 patients died.The mortality was 14.3%,and the mRS score was(3.8±1.0)points in the survivors.Conclusion The effect of multimodal image fusion combined with neuronavigation guided frameless stereotactic puncture and drainage in the treatment of brainstem hemorrhage is good,which can effectively remove brainstem hematoma,relieve the pressure of hematoma on brain stem,avoid secondary injury,reduce the mortality and disability rates,and improve the recovery.

关 键 词：脑干出血 继发性脑损伤 多模态 无框架立体定向 神经导航 影像融合 血肿抽吸引流术 

分 类 号：R743.34[医药卫生—神经病学与精神病学]