手術(shù)機(jī)器人聯(lián)合多模態(tài)影像融合技術(shù)輔助微創(chuàng)手術(shù)精準(zhǔn)治療中等量基底節(jié)區(qū)腦出血

【中圖分類號(hào)】 R651 【文獻(xiàn)標(biāo)志碼】 A 【文章編號(hào)】1672-7770（2025）02-0138-06

Abstract： Objective To explore the efficacy minimally invasive surgical techniques using surgical robots combined with multimodal image fusion technology in the treatment moderate basal ganglia hemorrhage. Methods clinical data 4O patients with moderate basal ganglia hemorrhage（ ）admitted to the s Dianjiang County People's and Emergency Center from January 2022 to May 2024 were analyzed retrospectively. Perfect preoperative imaging data such as plain head CT， difusion tensor imaging （DTI） and craniocerebral CTA. All patients underwent stereotactic minimaly invasive drilling and hematoma drainage assisted by surgical robots and multimodal image fusion technology， followed by postoperative injection urokinase into the hematoma cavity for liquefaction and drainage. Results All 40 patients successfuly completed the surgery. After one week surgery， the residual hematoma volume ， with a hematoma clearance rate （91.4±7.8）% .One month after surgery，DTI examination was performed to measure the anisotropy score（FA） the posterior limb the affected internal capsule， which was significantly increased compared to preoperative values. compresson the corticospinal tract（CST） on the affected side was significantly relieved， and the fiber bundle imaging was significantly increased compared to preopeative values. 3-month follow-up after surgery showed that all patients had improved neurological function. Conclusions For patients with moderate basal ganglia hemorrhage（ 20 - ）， minimally invasive surgery assisted by robots and multimodal image fusion technology can minimize iatrogenic injury， anatomicaly protect the CST， and provide a more precise and minimally invasive treatment.

Key words： basal ganglia hemorrhage； surgical robot； multimodal image fusion technology； corticospinal tract； diffusion tensor imaging

高血壓性腦出血（hypertensiveintracerebralhemorrhage，HICH）是腦卒中的一種嚴(yán)重類型，最常見的出血部位為基底節(jié)區(qū)。該區(qū)域因血腫壓迫和破壞內(nèi)囊后肢的皮質(zhì)脊髓束（corticospinaltract，CST）導(dǎo)致對(duì)側(cè)肢體運(yùn)動(dòng)功能障礙[1]，病情進(jìn)展迅速，死亡率和致殘率高[2]。對(duì)于血腫量 的中等量基底節(jié)區(qū)腦出血，目前通常采取保守治療，但長時(shí)間的血腫壓迫以及血腫分解產(chǎn)物引起的繼發(fā)性腦損傷，嚴(yán)重影響患者的神經(jīng)功能恢復(fù)[3]。因此，促進(jìn)血腫的吸收和清除被認(rèn)為是一種潛在有效的治療策略[4]。開顱血腫清除術(shù)，因血腫位置深、創(chuàng)傷大、手術(shù)時(shí)間長、術(shù)后并發(fā)癥發(fā)生率高，國內(nèi)外指南不推薦用于中等量基底節(jié)區(qū)腦出血[5]。微創(chuàng)鉆孔引流手術(shù)被認(rèn)為是創(chuàng)傷最小的手術(shù)方式，但傳統(tǒng)的徒手穿刺血腫難以做到精準(zhǔn)定位，手術(shù)中的偏差可能帶來嚴(yán)重的醫(yī)源性損傷[。隨著立體定向技術(shù)的發(fā)展，手術(shù)機(jī)器人聯(lián)合多模態(tài)影像融合技術(shù)的應(yīng)用，提供了一種更為安全和精準(zhǔn)的定位方法[7]。本研究通過多模態(tài)影像融合，可在手術(shù)過程中避開重要血管和白質(zhì)纖維束，減少對(duì)周圍腦組織的二次損傷[89]。本研究回顧性分析2022年1月—2024年5月重慶市墊江縣人民醫(yī)院神經(jīng)外科、重慶市急救醫(yī)療中心神經(jīng)外科收治的40例中等量 ）基底節(jié)區(qū)出血患者，現(xiàn)報(bào)告如下。

1資料與方法

1.1一般資料共納入40例中等量（ ）基底節(jié)區(qū)腦出血患者，其中男30例，女10例；年齡 歲，平均年齡（ 59±11 ）歲；出血量 ，平均 （26±3）mL ；入院時(shí)格拉斯哥昏迷指數(shù)（Glasgow coma scale，GCS）評(píng)分（ 分；人院時(shí)改良Rankin量表（modifiedRankin scale，mRS）評(píng)分 （4.18±0.39） ）分；……