神经内镜治疗高血压脑出血疗效研究及多田公式准确性评价

发布时间：2018-05-31 05:53

本文选题：高血压脑出血 + 神经内镜　；参考：《中国人民解放军医学院》2015年硕士论文

【摘要】：目的：通过与传统开颅血肿清除手术比较,探讨神经内镜血肿清除术在高血压脑出血治疗中的疗效和价值；利用3D-Slicer软件精确测量脑出血病人脑内血肿体积,与多田公式计算结果比较,研究多田公式的准确性。方法：此研究包含两个部分。第一部分方法：总结2010年6月到2014年6月在我院神经外科接受手术的151例幕上高血压脑出血患者,根据患者手术方式分为内镜手术组(82例)和开颅手术组(69例),采用3D-Slicer软件精确测量患者手术前后血肿体积,计算血肿清除效率,同时比较两组患者手术耗时、手术中失血量、手术后1周格拉斯哥昏迷评分(Glasgow Coma Scale, GCS)、住院时间和手术后6个月改良Rankin量表(Modified Rankin Scale, mRS)评分方面的差别。第二部分方法：收集我院神经外科2010年6月到2014年6月收治的192例脑出血患者头颅CT数据资料,依次应用3D-Slicer软件和多田公式测量血肿体积。将血肿依据3D-Slicer软件测量结果大小分为：一组30mL(n=57),二组30-60mL(n=71),三组60mL(n=64)；依据血肿形状分为：形状规则组(n=62),形状不规则组(n=111)和分叶状组(n=19)。分别按照血肿大小和血肿形状对两种方法结果进行分析比较。结果：第一部分结果：内镜手术组患者与开颅手术组患者各项术前基线资料均无统计学差异(P值均0.05)。内镜手术组血肿清除率90.5%±6.5%,开颅手术组血肿清除率82.3%±8.6%(P0.01)；手术时间,内镜手术组(1.6±0.7)h,开颅手术组(5.2±1.8)h(P0.01)；手术中失血量,内镜手术组(91.4±93.1)mL,开颅手术组(605.6±602.3)mL(P0.01)；手术后1周GCS评分,内镜手术组11.5±2.9,开颅手术组8.3±3.8(P0.01)；住院时间,内镜手术组(11.6±6.9)d,开颅手术组(13.2±7.9)d(P0.05)；手术后6个月mRS评分,内镜手术组3.2±1.5,开颅手术组4.1±1.9,内镜手术组患者术后6个月mRS评分优于开颅手术组患者(P0.01)。第二部分结果3D-Slicer软件法血肿平均体积(50.3±31.9)mL,多田公式法血肿平均体积(58.4±37.8)mL,差异具有统计学意义(t=8.134,P0.01),多田公式法血肿体积测量结果明显高于3D-Slicer软件法,多田公式平均测量误差8.1mL,误差率16.4%±9.2%。根据血肿体积大小分组,多田公式法测量误差：一组3.2mL(17.7%),二组5.7mL(13.7%),三组15.0mL(17.5%)；根据血肿形状分组,多田公式法测量误差：形状规则组3.4mL(9.8%),形状不规则组7.0mL(18.3%),分叶状组29.2mL(39.1%)。结论：神经内镜脑内血肿清除手术,与传统开颅血肿清除手术比较,创伤小术中出血少,血肿清除率高,并能改善高血压脑出血患者预后,具有较好应用价值,随着技术的不断完善和进步,神经内镜血肿清除术将越来越成熟和普及。传统多田公式是一种粗略的血肿体积估算方法,计算结果往往大于血肿实际体积,尤其对于形状不规则血肿的估算误差更大,计算误差主要取决于血肿的形状,3D-Slicer软件测量脑内血肿体积具有准确、快捷、免费的优点,有利于临床研究的标准化和科学性。
[Abstract]:Objective : To compare the efficacy and value of neuroendoscope hematoma removal in the treatment of hypertensive intracerebral hemorrhage ( ICH ) by comparing with traditional skull hematoma removal surgery .
The accuracy of multi - field formula was studied by using 3D - Slicer software to accurately measure the volume of intracerebral hematoma in patients with intracerebral hemorrhage .
According to the shape of hematoma , the shape of hematoma was divided into shape rule group ( n = 62 ) , irregular shape group ( n = 111 ) and lobate group ( n = 19 ) . The results showed that there was no statistical difference between the baseline data of hematoma size and hematoma shape ( P < 0.05 ) . The hematoma clearance rate in endoscopic surgery group was 90.5 % 卤 6.5 % , and hematoma clearance rate was 82.3 % 卤 8.6 % ( P0.01 ) .
The operative time , endoscopic surgery group ( 1.6 卤 0.7 ) h and operation group ( 5.2 卤 1.8 ) h ( P0.01 ) .
The volume of blood loss in operation , endoscopic surgery group ( 91.4 卤 93.1 ) mL and operation group ( 605.6 卤 602.3 ) mL ( P0.01 ) .
GCS score of 1 week after surgery , 11.5 卤 2.9 in endoscopic surgery group and 8.3 卤 3.8 ( P0.01 ) .
The time of hospitalization , endoscopic surgery group ( 11.6 卤 6.9 ) d and operation group ( 13.2 卤 7.9 ) d ( P0.05 ) .
Results 3D - Slicer software was used to measure the mean volume of hematoma ( 50.3 卤 31.9 ) mL , and the mean volume of hematoma ( 58.4 卤 37.8 ) mL was significantly higher than that of 3D - Slicer software .
Conclusion : The traditional multi - field formula is a rough volumetric estimation method of hematoma , which is more and more mature and popular with the continuous improvement and progress of the technique . The traditional multi - field formula is a rough volumetric estimation method .
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

【参考文献】