术中VR辅助神经内镜下血肿清除术与立体定向颅内血肿引流术治疗基底节区HICH的疗效分析

doi:10.19854/j.cnki.1008-2425.2024.01.0007

摘要/Abstract

摘要： 目的探究基底节区高血压性脑出血(HICH)患者采用术中虚拟现实技术(VR)辅助神经内镜下血肿清除术与立体定向引流术治疗的疗效。方法选取2022年9月-2023年5月医院收治的106例HICH患者为研究对象,以随机数字表法分为A组与B组,A组进行术中VR辅助神经内镜下血肿清除术(NEIHE)治疗,B组进行立体定向颅内血肿引流术治疗。比较两组围手术期指标、穿刺情况、血肿清除情况及术前、术后3个月的炎症指标水平,观察两组术后3个月的预后情况。结果 A组手术时间长于B组,术后血肿引流时间及住院时间短于B组(P＜0.05);A组首次穿刺成功率高于B组,术后1 d、5 d血肿清除率高于B组(P＜0.05);两组术后3个月的血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平较术前低,且A组低于B组(P＜0.05);两组术后3个月的美国国立卫生研究院卒中量表( NIHSS)评分均降低,且A组低于B组,两组Barthel(BI)指数均升高,且A组高于B组(P＜0.05)。结论相较于立体定向颅内血肿引流术,术中VR辅助NEIHE虽然手术时间较长,但能提高术中穿刺成功率及血肿清除率,缩短患者术后血肿引流时间及住院时间,并能减轻机体炎症反应,促进患者神经功能与日常生活能力的恢复。

关键词: 颅内血肿清除术, 立体定向血肿引流, 高血压性脑出血, 虚拟现实技术, 神经内镜, 立体定向

Abstract: Objective To explore the efficacy of intraoperative virtual reality (VR) assisted neuroendoscopic hematoma removal and stereotactic drainage in patients with hypertensive intracerebral hemorrhage (HICH) in the basal ganglia region. Methods 106 HICH patients admitted to the hospital from September 2022 to May 2023 were selected as the study subjects.They were divided into group A and group B by random number table method.Group A was treated with intraoperative VR-assisted neural endoscopic hematoma evacuation (NEIHE),and group B was treated with stereotactic intracranial hematoma drainage surgery.The perioperative indicators,puncture conditions,hematoma clearance,and levels of inflammatory indicators before and 3 months after surgery were compared between the two groups,and the prognosis of the two groups 3 months after surgery was observed. Results The surgical time in Group A was longer than that in Group B,and the postoperative hematoma drainage time and hospitalization time were shorter than those in Group B (P＜0.05).The success rate of the first puncture in Group A was higher than that in Group B,and the hematoma clearance rate on the 1st and 5th day after surgery was higher than that in Group B (P＜0.05).The levels of serum C-reactive protein (CRP),interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the two groups were lower than those before operation,and those in group A were lower than those in group B at 3 months after operation (P＜0.05).The National Institutes of Health Stroke Scale (NIHSS) scores of both groups decreased 3 months after surgery,and Group A was lower than Group B.The Barthel (BI) index increased in both groups,and Group A was higher than Group B (P＜0.05). Conclusion Compared to stereotactic intracranial hematoma drainage,intraoperative VR assisted NEIHE can improve the success rate of intraoperative puncture and hematoma removal rate,shorten the postoperative hematoma drainage time and hospitalization time of patients,reduce the body's inflammatory response,and promote the recovery of neurological function and daily life ability of patients.

Key words: Removal of intracranial hematoma, Stereotactic hematoma drainage, Hypertensive cerebral hemorrhage, Virtual reality technology, Neuroendoscopy, Stereotactic orientation

中图分类号:

R743.2

武强, 韩志强, 赵建春, 庞一强, 张海涛, 田伟霞, 兰晓艳, 郝晨阳. 术中VR辅助神经内镜下血肿清除术与立体定向颅内血肿引流术治疗基底节区HICH的疗效分析[J]. 立体定向和功能性神经外科杂志, 2024, 37(1): 33-38.

Wu Qiang, Han Zhiqiang, Zhao Jianchun, Pang Yiqiang, Zhang Haitao, Tian Weixia, LAN Xiaoyan, Hao Chenyang. Analysis of the therapeutic effects of intraoperative VR assisted neuroendoscopic hematoma removal and stereotactic intracranial hematoma drainage in the treatment of basal ganglia HICH[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(1): 33-38.

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