多模态神经导航联合皮层电刺激技术在中央区肿瘤中的临床研究

发布时间：2018-03-14 02:18

本文选题：神经导航　切入点：磁共振弥散张量成像　出处：《新乡医学院》2014年硕士论文　论文类型：学位论文

【摘要】：背景近年来计算机技术迅猛发展,神经导航系统可以对各种图像数据进行融合；神经导航系统已经由单纯解剖导航向功能导航方向发展。通过对多种影像资料的融合,多模态神经导航可以在术前合理规划手术切口及入路避开重要功能结构,术中对脑肿瘤及邻近重要功能结构进行实时监测,实现最大程度切除肿瘤并最小限度损伤神经功能。2012年中国人民解放军第一五三医院引进BrainLAB多模态神经导航系统。目的探讨多模态神经导航手术与传统手术在治疗中央区脑肿瘤各环节的差异；并比较两者对神经功能的保护。资料和方法 1研究对象经医院伦理委员会同意,回顾性分析郑州市解放军第153中心医院2009-2013年收治的中央区颅脑肿瘤患者共64例。年龄14-73岁,其中男性35例,女性29例。病理结果显示：胶质瘤40例,脑膜瘤16例,转移癌2例,海绵状血管瘤3例,脑脓肿1例,病理性钙化2例。 2分组方法依据相关治疗开展时间不同分为电生理组33例,神经导航组31例。电生理组病例按照传统解剖学定位方式标记手术切口,术中实施皮层及皮层下电刺激保护重要神经功能结构。神经导航组术前重建3D解剖结构、描绘肿瘤范围并行纤维束示踪,评估手术风险,在计划工作站上设计手术切口及入路,术中执行皮层电刺激保护运动区皮层,导航图像实时引导切除肿瘤皮层下部分保护纤维束而不进行皮层下电刺激。术后1月对所有病例进行神经功能及切除程度评估。 3统计学分析采用SPSS17.0统计学软件处理,计量资料采用t检验,计数资料采用x2检验,设定α=0.05为检验水准,P0.05有统计学意义。结果导航组全切除27例,次全切除2例,大部切除1例,部分切除1例,全切率87.1%；电生理组全切除19例,次全切除9例,大部切除3例,部分切除1例,全切率57.6%。,两组差异具有统计学意义(P0.05)。手术前后KPS评分比较,Kpost电(83.94±7.04)与Kpre电(79.70±12.12)比较,t值2.235,差异有统计学意义(配对t检验,P0.05)。Kpost导(89.03±7.00)与Kpre电(79.68±10.80)比较,t值5.609,差异有统计学意义(配对t检验,P0.05)。手术前后KPS评分变化量比较,△KPS导(9.35±9.29)与△KPS电(4.24±10.91)比较,t值2.013,差异有统计学意义(独立样本t检验,P0.05)。电生理组手术时间(153.26±27.50min)与导航组手术时间(130.38±27.92min),t值3.220,差异有统计学意义(独立样本t检验,P0.05)。结论 1、应用神经导航系统可以在手术前合理设计手术切口与入路；2、术中应用神经导航进行纤维束示踪,可以对大脑功能结构进行预判,指导术中电刺激操作并准确定位病变位置；3、神经导航应用于临床,能提高中央区脑肿瘤的全切率,降低术后神经功能障碍的发生率。
[Abstract]:Background. In recent years, with the rapid development of computer technology, the neural navigation system can fuse all kinds of image data, and the neural navigation system has been developed from anatomic navigation to functional navigation. Multimodal neuronavigation can reasonably plan surgical incision and approach before operation to avoid important functional structures, and monitor brain tumors and adjacent important functional structures in real time. The BrainLAB multimodal neuronavigation system was introduced into the 153 Hospital of the Chinese people's Liberation Army in 2012. Purpose. To explore the differences between multimodal neuronavigation and traditional operation in the treatment of brain tumors in central region, and to compare the protection of nerve function between them. Information and methodology. 1 object of study. With the consent of the Hospital Ethics Committee, 64 patients with craniocerebral tumors in the Central District, aged 14-73 years, admitted to the 153 Central Hospital of the people's Liberation Army of Zhengzhou from 2009 to 2013, were retrospectively analyzed, including 35 males and 29 females. The pathological results showed that 40 cases were gliomas. There were 16 cases of meningioma, 2 cases of metastatic carcinoma, 3 cases of cavernous hemangioma, 1 case of brain abscess and 2 cases of pathological calcification. 2 grouping method. According to the time of related treatment, the patients were divided into electrophysiological group (n = 33) and neuronavigation group (n = 31). The nerve navigation group reconstructed 3D anatomical structure before operation, described the tumor area and tracer of fiber bundle, evaluated the operation risk, designed the surgical incision and approach on the plan workstation. Intraoperative electrical stimulation was performed to protect the motor cortex, and navigation images were used to guide the removal of subcortical protective fibers instead of subcortical electrical stimulation. On January, the neurologic function and the degree of resection were evaluated in all patients. 3Statistical analysis. The SPSS17.0 software was used to process the data, the measurement data was t-test, the count data was x2 test, and the test level of 伪 -0. 05 was significantly higher than that of the control group (P0.05). Results. In the navigation group, there were 27 cases of total resection, 2 cases of subtotal resection, 1 case of subtotal resection, 1 case of partial resection, 87.1% of total resection rate, 19 cases of total resection, 9 cases of subtotal resection, 3 cases of subtotal resection and 1 case of partial resection in electrophysiological group. The total resection rate was 57.60.The difference between the two groups was statistically significant (P 0.05). The comparison of KPS scores before and after operation was 83.94 卤7.04) compared with that of Kpre (79.70 卤12.12). The difference was statistically significant (paired t test (P 0.05) .Kpost guide 89.03 卤7.00) and Kpre electricity (79.68 卤10.80). The difference was significant (P 0.05 卤7.00) and Kpre (79.68 卤10.80). Comparison of KPS scores before and after operation, There was significant difference between KPS (9.35 卤9.29) and KPS (4.24 卤10.91). The difference was statistically significant (independent sample t test, P 0.05). The operation time of electrophysiology group was 153.26 卤27.50 minutes, and the operating time of navigation group was 3.220, which was significantly different from that of navigation group (independent sample t test, P 0.05). Conclusion. 1. The application of neuronavigation system can reasonably design the incision and approach before the operation, and the nerve navigation can be used to trace the fiber bundle during the operation, and the functional structure of the brain can be forecasted. In order to guide the operation of intraoperative electrical stimulation and accurately locate the location of the lesion, neuronavigation can improve the total resection rate of brain tumors in the central region and reduce the incidence of postoperative neurological dysfunction.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

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