3Dslicer联合Sina软件辅助神经内镜下微创治疗幕上高血压脑出血的应用研究及其预后影响因素分析

doi:10.19854/j.cnki.1008-2425.2023.03.0008

摘要/Abstract

摘要： 目的研究3Dslicer联合Sina软件辅助神经内镜下微创手术治疗幕上高血压脑出血(Supratentorial hypertensive intracerebral hemorrhage,SHICH)的优势,分析患者的预后影响因素。方法回顾性分析188例SHICH病人的相关临床资料,根据其微创手术方案分成3Dslicer联合Sina软件辅助神经内镜微创手术组与单纯显微镜下微创手术组。比较并分析两组患者血肿清除率、骨窗面积、骨窗与血肿投影重合率、手术时间、术中出血量、围手术期并发症及预后的差异。通过单变量及多变量回归分析筛选出可能影响SHICH术后神经功能预后的相关因素。结果 3Dslicer联合Sina软件辅助神经内镜与单纯显微镜下微创组相比骨窗与血肿投影重合率、血肿清除率增高,手术时间及术中出血量减少,术后3月GOS评分明显提升而围手术期并发症发生率减少;多因素二元Logistic回归分析显示:术前GCS评分、术前血肿体积及手术血肿清除率、血肿部位、手术方式、围手术期并发症及术后综合康复治疗为幕上高血压脑出血手术患者预后独立影响因素。结论 3D-slicer联合Sina软件辅助内镜下手术使微创手术水平进一步提升,显著提高了幕上脑出血手术术前血肿定位及手术规划的精确度,优化骨窗面积、减少手术时间与术中出血量,提升血肿清除率,减少围手术期并发症并明显改善临床预后;术前GCS评分、手术血肿清除率、手术方式(采用3D-slicer辅助组)、血肿部位(非丘脑部位)、术后综合康复治疗为患者预后的保护因素,术前血肿体积及围手术期并发症为患者预后的危险因素,临床医生应及早对以上因素进行综合分析和评估,采用合适的微创治疗手段并积极地防治并发症,以期获得更好的神经功能恢复。

关键词: 3Dslicer, 幕上高血压脑出血, 神经内镜, 预后

Abstract: Objective To investigate the advantages of 3Dslicer combined with Sina software assisted neuroendoscopic minimally invasive surgery in the treatment of supratentorial hypertensive cerebral hemorrhage,and analyze the prognostic factors of patients.Methods The relevant clinical data of 188 patients with SHICH were retrospectively analyzed,and according to their minimally invasive surgery plan,they were divided into 3Dslicer combined with Sina software assisted neuroendoscopic minimally invasive surgery group and microscopic minimally invasive surgery group.The differences of hematoma clearance rate,bone window area,coincidence rate of bone window and hematoma projection,operation time,intraoperative blood loss,perioperative complications and prognosis between the two groups were compared and analyzed.Through univariate and multivariate regression analysis,the related factors that may affect the prognosis of neurological function after SHICH surgery were screened out.Results 3Dslicer combined with Sina assisted neuroendoscopy increased the coincidence rate of bone window and hematoma projection and the clearance rate of hematoma,the operation time and intraoperative blood loss decreased,the GOS score increased significantly 3 months after surgery and the incidence of perioperative complications decreased.Multivariate binary Logistic regression analysis showed that preoperative GCS score,preoperative hematoma volume,surgical hematoma clearance rate,hematoma site,surgical method,perioperative complications and postoperative comprehensive rehabilitation were independent factors influencing prognosis of patients undergoing supratentorial hypertensive intracerebral hemorrhage surgery.Conclusion 3D-slicer combined with Sina software assisted endoscopic surgery further improved the level of minimally invasive surgery,significantly improved the accuracy of hematoma positioning and surgical planning before supratentorial intracranial hemorrhage surgery,optimized bone window area,reduced operative time and intraoperative blood loss,increased hematoma clearance rate,reduced perioperative complications,and significantly improved clinical prognosis.Preoperative GCS score,surgical hematoma clearance rate,surgical method (3D-slicer assisted group),hematoma site (non-thalamic site),postoperative comprehensive rehabilitation treatment were protective factors for prognosis of patients.Preoperative hematoma volume and perioperative complications were risk factors for prognosis of patients.Clinicians should conduct comprehensive analysis and evaluation of the above factors as early as possible,adopt appropriate minimally invasive treatment and actively prevent and treat complications,in order to obtain better neurological function recovery.

Key words: 3Dslicer, Supratentorial hypertensive cerebral hemorrhage, Neuroendoscopy, Prognosis

中图分类号:

R743.34

李丛丛, 王献峰, 赵市伟, 胡月龙, 巴永峰, 张超勇. 3Dslicer联合Sina软件辅助神经内镜下微创治疗幕上高血压脑出血的应用研究及其预后影响因素分析[J]. 立体定向和功能性神经外科杂志, 2023, 36(3): 171-177.

Li Congcong, Wang Xianfeng, Zhao Shiwei, et al. Application research of 3Dslicer combined with Sina software assisted neuroendoscopy in minimally invasive treatment of supratentorial hypertensive cerebral hemorrhage and analysis of prognostic factors[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(3): 171-177.

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