无框架立体定向穿刺技术治疗功能区脑脓肿

发布时间：2018-01-16 18:21

本文关键词：无框架立体定向穿刺技术治疗功能区脑脓肿　出处：《扬州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨无框架立体定向穿刺技术在治疗功能区脑脓肿的优势及临床诊断治疗过程中的注意事项,提高功能区脑脓肿的临床治疗水平。方法：对扬州市第一人民医院神经外科自2012年12月至2013年5月收治的3例颅内占位的患者进行治疗。三例患者术前均行头颅MRI平扫+增强提示边缘强化的囊性病变,高度怀疑脑脓肿。术前1天头部贴Mark后均行MRI层厚3mm的薄层扫描；麻醉后按照患者病变位置摆放合适手术体位；安装由南京麦迪柯公司生产的MD-2000A1型立体定向手术系统(无框架扫描脑立体定向手术系统)的专用头架；并将术前的MRI薄层图像导入计算机工作站与手术计划系统,根据工作站的图像融合结果确定病灶靶点,避开功能区及重要的血管神经确定入颅点、穿刺路径及深度；依据穿刺路径确定手术切口,头皮切开并颅骨钻孔,选择合适的系统自带穿刺针进行穿刺,有突破感后用5ml注射器进行抽吸浓液并冲洗维持适当脓肿腔液体张力,拔出穿刺针更换硅胶引流管,再次冲洗,并戳孔引出接引流瓶,缝扎可靠固定,术后予以抗感染及支持对症治疗,进行头颅CT复查,术后1月、3月分别行头颅MRI复查,并对随访结果进行分析。结果：3例患者穿刺均一次性成功,分别抽出脓性液体进行培养、涂片,仅1例培养阳性,1例涂片为革兰阳性球菌,1例涂片为大量中性粒细胞。3例患者中1例术后脓肿未明显减少,行再次穿刺外引流后治愈。3例患者4次手术时间分别为1.5h,1h,1.5h,0.5h,平均1.1h。术后未出现手术并发症及神经功能缺失症状,原有神经功能障碍明显好转,治愈出院。出院后随访行影像学检查,脓肿腔均消失,随访时间分别为15月,13月,10月,未见复发。结论：无框架立体定向穿刺技术具有操作简单,穿刺准确,手术时间短,术后并发症少,安全性高,可以反复穿刺等优点,是治疗脑脓肿特别是功能区脑脓肿的重要手术方式；对于术前高度怀疑的脑脓肿患者,无框架立体定向穿刺技术可以在明确诊断的同时进行抽吸治疗；无框架立体定向穿刺技术对于功能区脑脓肿患者解除脑压迫、缓解症状、恢复功能具有重要意义。
[Abstract]:Objective: to explore the advantages of frameless stereotactic puncture in the treatment of brain abscess in functional area and the points for attention in clinical diagnosis and treatment, and to improve the clinical treatment level of brain abscess in functional area. Methods: from December 2012 to May 2013, 3 patients with intracranial space occupying were treated in the neurosurgery department of the first people's Hospital of Yangzhou. All three patients underwent MRI scan before operation. Contrast enhancement suggests marginal enhancement of cystic lesions. The brain abscess was highly suspected. After Mark was applied to the head 1 day before operation, the thin layer scanning of MRI layer thickness of 3 mm was performed. After anesthesia, according to the pathological position of the patients, the proper position of the operation was placed. Installing the special head frame of the MD-2000A1 stereotactic surgery system (frameless scan brain stereotactic surgery system) produced by Nanjing Medica Company; The thin MRI images were imported into the computer workstation and the operation planning system. According to the image fusion results of the workstation, the focus targets were determined, and the cranial sites were determined by avoiding the functional areas and important vessels and nerves. Puncture path and depth; According to the puncture path to determine the surgical incision, scalp incision and skull drilling, select the appropriate system with the puncture needle for puncture. After a breakthrough, a 5ml syringe was used to draw the concentrated liquid and wash and maintain the proper liquid tension of the abscess cavity. The puncture needle was pulled out to replace the silica gel drainage tube, then flushed again, and the hole was poked out to lead to the drawing bottle, and the suture was reliably fixed. MRI was performed on January and March, and the follow-up results were analyzed. Results all of the 3 cases were successfully punctured and cultured with purulent fluid. Only 1 case was positive for culture and 1 case was Gram-positive cocci. One case was smeared with a large number of neutrophilic granulocytes, 1 case had no obvious decrease of abscess after operation, and 3 cases were cured after re-puncture and drainage for 1.5 h or 1.5 h respectively. 0.5 h, average 1.1 h. There were no postoperative complications and neurological deficit symptoms. The original neurological dysfunction was obviously improved and was cured and discharged. After discharge, the abscess cavity disappeared. The follow-up time was 15 months, 13 months and October, respectively. No recurrence was found. Conclusion: frameless stereotactic puncture has the advantages of simple operation, accurate puncture, short operation time, less postoperative complications, high safety and so on. It is an important operative method for the treatment of brain abscess, especially the brain abscess in the functional area. For preoperatively highly suspected brain abscess patients, frameless stereotactic puncture technique can be used to treat the brain abscess at the same time of definite diagnosis. Frameless stereotactic puncture plays an important role in relieving brain compression, relieving symptoms and restoring function in patients with functional brain abscess.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R651.1

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