神经导航联合术中神经电生理监测在幕上病变显微切除中的临床应用

发布时间：2018-06-06 11:20

本文选题：神经导航 + 神经电生理　；参考：《石河子大学》2017年硕士论文

【摘要】：目的:研究观察神经导航联合术中神经电生理监测运用于幕上病变显微切除的可行性、安全性及近期临床疗效。方法:对我院神经外科2013年1月至2016年6月手术治疗的幕上病变患者的临床资料进行回顾性分析,选择其中使用神经导航及术中电生理监测辅助技术的首次经手术治疗的患者共33例作为研究组,选择同等数量的仅在显微镜下切除的幕上病变患者为对照组。观察比较两组术后骨窗最大径与术前同层面病变最大径之差,术中持续时间、术中出血量,术后住院时长,病变切除程度,术后症状缓解情况,术后并发症及术后随访近期预后及复发情况。结果:研究组和对照组患者年龄、性别、病理类型、病变位置、病变大小、术前KPS评分等均无统计学差异。研究组术后骨窗最大径与术前同层面病变最大径之差为22.94±13.64mm,对照组术后骨窗最大径与术前同层面病变最大径之差为32.33±12.34mm;两组差异有统计学意义(p0.05)。研究组术中出血量平均为220.15±144.93ml,手术持续时间平均为222.48±60.52min,术后住院时间平均为16.88±9.36日,与对照组进行比较术中出血、术后住院时长差异均有统计学意义(p0.05)。研究组全切27例,次全切3例,大部分切除2例,部分切除1例,全切率为81.82%;对照组全切18例,次全切9例,大部分切除4例,部分切除2例,全切率54.55%;两组差异明显有统计学意义(p0.05)。研究组术前KPS评分平均为75.45±22.91,出院前KPS评分平均为88.79±18.16,术后3月KPS评分为89.09±19.90;对照组术前KPS评分平均为71.21±26.55,出院前KPS评分平均为74.24±29.69,术后3月KPS评分为68.48±35.98;出院前、术后3月KPS评分两组比较差异均有统计学意义(p0.05)。使用了神经导航联合电生理技术对于术后症状改善及近期并发症的发生率有明显改善,且差异有统计学意义(p0.05)。结论:联合使用神经导航技术及术中神经电生理检测技术辅助切除幕上病变安全、可行;联合使用神经导航技术及术中神经电生理检测技术能缩小骨窗并准确定位病变,提高幕上病变手术切除的全切率,尤其是脑膜瘤;术中能明显减少术中出血、缩短术后住院时长;术后能明显改善患者症状及降低并发症发生。
[Abstract]:Objective: to study the feasibility, safety and clinical effect of intraoperative nerve electrophysiological monitoring combined with neuronavigation in microresection of supratentorial lesions. Methods: the clinical data of patients with supratentorial diseases treated by neurosurgery from January 2013 to June 2016 were retrospectively analyzed. A total of 33 patients who were treated with neuronavigation and intraoperative electrophysiological monitoring were selected as the study group, and the same number of patients with supratentorial diseases were selected as the control group. The difference of the maximum diameter of bone window between the two groups before and after operation, the duration of operation, the amount of intraoperative bleeding, the length of hospitalization after operation, the degree of resection of lesion and the relief of postoperative symptoms were observed and compared between the two groups. Postoperative complications, short-term prognosis and recurrence after follow-up. Results: there were no significant differences in age, sex, pathological type, lesion location, lesion size and preoperative KPS score between the study group and the control group. The difference between the two groups was 22.94 卤13.64mm and 32.33 卤12.34mm respectively. The difference between the two groups was statistically significant (p 0.05). The average amount of intraoperative bleeding was 220.15 卤144.93 ml, the mean duration of operation was 222.48 卤60.52 min, and the average postoperative hospitalization time was 16.88 卤9.36 days. Compared with the control group, the mean intraoperative bleeding was 220.15 卤144.93 ml, the average duration of operation was 222.48 卤60.52 min, and the length of hospitalization was significantly different from that of the control group (P 0.05). In the study group, there were 27 cases of total resection, 3 cases of subtotal resection, 2 cases of partial resection, and 1 case of partial resection, with a total resection rate of 81.82%, while in the control group, 18 cases had total resection, 9 cases had subtotal resection, 4 cases had partial resection, 2 cases had partial resection. The total cutting rate was 54.55, and the difference between the two groups was statistically significant (P 0.05). The mean preoperative KPS score was 75.45 卤22.91, the average KPS score before discharge was 88.79 卤18.16, the KPS score was 89.09 卤19.90 3 months after discharge, the average KPS score was 71.21 卤26.55 in the control group, the average KPS score before discharge was 74.24 卤29.69, and the KPS score before discharge was 68.48 卤35.98. There was significant difference in KPS score between the two groups 3 months after operation (P 0.05). The use of neuronavigation combined with electrophysiologic techniques significantly improved the postoperative symptoms and the incidence of recent complications, and the difference was statistically significant (P 0.05). Conclusion: the combined use of neuronavigation and intraoperative nerve electrophysiological examination is safe and feasible for the resection of supratentorial lesions, and the combined use of neuronavigation and intraoperative nerve electrophysiological detection can reduce the bone window and accurately locate the lesion. To improve the total resection rate of supratentorial lesions, especially meningioma; to reduce intraoperative bleeding, shorten the length of postoperative hospital stay; postoperative can significantly improve the symptoms of patients and reduce the incidence of complications.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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