2021 年第 9 期 第 16 卷

3D-slicer软件联合神经内镜手术治疗高血压基底节区脑出血的临床效果及安全性

Clinical effect and safety of 3D-slicer combined with neuroendoscopic surgery on hypertensive basal ganglia hemorrhage

作者：李知阳王文举魏航宇宋平陈晓煜蔡强

英文作者：Li Zhiyang Wang Wenju Wei Hangyu Song Ping Chen Xiaoyu Cai Qiang

单位：武汉大学人民医院神经外科430060

英文单位：Department of Neurosurgery Renmin Hospital of Wuhan University Wuhan 430060 China

关键词：基底节区脑出血；3D-slicer；神经内镜；钻孔引流术

英文关键词：Basalgangliahemorrhage;3D-slicer;Neuroendoscopy;Drillinganddrainage

• 摘要：

• 目的 探讨3D-slicer软件联合神经内镜手术治疗高血压基底节区脑出血的临床效果及安全性。方法 回顾性分析2019年1月至2020年10月武汉大学人民医院神经外科收治的72例高血压基底节区脑出血患者的临床资料，其中32例行3D-slicer软件联合神经内镜血肿清除术（内镜组），40例行CT定位下钻孔引流术（钻孔组）。比较2组一般资料、术前血肿容积、血肿清除率、术后水肿带最大直径、术后再出血比例、颅内感染比例、引流管拔除时间、出院格拉斯哥昏迷量表（GCS）评分及改良Rankin量表（mRS）评分。术后CT检查引流管置管准确情况。结果 2组患者性别、年龄、高血压比例、入院收缩压、入院GCS评分及术前血肿容积比较，差异均无统计学意义（均P＞0.05）。内镜组术后第1、7天血肿清除率 ［术后第1天：（93.4±6.1）%比（61.2±10.2）%；术后第7天：（98.7±1.4）%比（90.5±3.5）%］及出院GCS评分均高于钻孔组，差异均有统计学意义（均P＜0.01）。内镜组术后第7天水肿带最大直径、术后再出血比例、颅内感染比例、引流管拔管时间均小于/短于钻孔组（均P＜0.05）。内镜组引流管置管准确率明显高于钻孔组，差异有统计学意义［100.0%（32/32）比85.0%(34/40)］（χ2=5.24，P=0.02）。结论 3D-slicer软件联合神经内镜手术治疗高血压基底节区脑出血安全有效，具有血肿清除率高、并发症发生率低、患者预后好等优势。

• Objective To investigate the clinical effect and safety of 3D-slicer combined with neuroendoscopic surgery on hypertensive basal ganglia hemorrhage. Methods From January 2019 to October 2020, clinical data of 72 patients with hypertensive basal ganglia hemorrhage admitted to Department of Neurosurgery, Renmin Hospital of Wuhan University were retrospectively analyzed. Among them, 32 patients underwent 3D-slicer combined with neuroendoscopic surgery (endoscopic group) and 40 patients underwent drilling and drainage under CT positioning(drilling group). General information, preoperative hematoma volume, hematoma clearance rate, postoperative edema zone maximum diameter, postoperative rebleeding rate, intracranial infection rate, drainage tube removal time, discharged Glasgow Coma Scale （GCS） score and modified Rankin scale (mRS) score were compared between the two groups. CT was used to check the accuracy of drainage tube. Results There were no significant differences in gender, age, proportion of hypertension, admission systolic blood pressure, admission GCS score, and preoperative hematoma volume between the two groups (all P>0.05). The hematoma clearance rates on 1 and 7 d after operation［1 d after operation:（93.4±6.1）% vs （61.2±10.2）%; 7 d after operation:（98.7±1.4）% vs （90.5±3.5）%］ and discharged GCS score in the endoscopic group were higher than those in the drilling group(all P<0.01). The edema zone maximum diameter on 7 d after operation, postoperative rebleeding rate, intracranial infection rate, drainage tube removal time in the endoscopic group were less/shorter than those in the drilling group(all P<0.05). The accurate rate of drainage tube placement in the endoscopic group was higher than that in the drilling group［100.0%(32/32) vs 85.0%(34/40)］（χ2=5.24， P=0.02）. Conclusions 3D-slicer combined with neuroendoscopic surgery is safe and effective for hypertensive basal ganglia hemorrhage. It has the advantages of high hematoma clearance, low complication rate, and good prognosis.