多模態影像輔助手術與傳統開顱術在腦深部血腫的應用療效和預后比較

【中圖分類號】 R651 【文獻標志碼】 B 【文章編號】 1672-7770（2025）03-0325-05

Abstract：ObjectiveTo compare the efficacy and prognosis between multimodal surgery and traditional craniotomy in deep cerebral hematoma.MethodsAtotal of 65 patients with deep cerebral hemorrhage who underwent surgical treatment in Department of neurosurgery， from January1，2018 to December31，2022 wereanalyzed retrospectively，and they were divided into conventional groupand minimally invasive group according tosurgical methods.There were 32 patients receivedmultimodal minimally invasive puncture surgery and33patientsreceived conventional craniotomy surgery.Preoperativeand postoperative head computed tomography（CT）examinations were performed to confirm the diagnosis in both groups.Preoperative and postoperative hematoma volume，length of hospital stay，Glasgow outcome scale（GOS）score and national institute of health stroke scale（NIHSS）score of patients 6 months after surgery，and postoperative adverse events were recorded.Hematoma clearance rate，GOS score，NIHSS score 6 months after operation and the incidence of adverse events were compared between the two surgical methods.ResultsThere were no significant diferences in age，gender，blood pressure and underlying diseases between the two groups （ Pgt;0. 05 ）．The NIHSS score difference and hematoma clearance rate of the two groups were statistically significant（ Plt;0.05 ）．Postoperative adverse events，NIHSS score before surgery，GOS score 6 months after surgery and length of hospital stay were not statistically significant between the two groups （ Pgt;0 .05）．ConclusionsFor thepatients with deep cerebral hematoma，multimodal surgery has more advantages for the improvement of postoperative qualityof lifeand has better hematoma clearance rate.

Key words：multimodal surgery；deep cerebral hematoma；applied effect；prognosis

腦出血是一種高死亡率的卒中亞型（1個月內死亡率約為 40% ），而存活下來的部分患者通常都伴有非常嚴重的神經損傷，在全球范圍內每年約有200萬的新發病例，占所有卒中的 10%～15% ，在亞洲比例約為 20%～30%^[1] 由于腦出血量與死亡率和不良功能預后密切相關，因此手術治療腦出血一直是被提倡的方法[2]。利用影像引導及微創手術，已開發多種新方法及技術輔助手段，目的是減輕對周圍未受血腫影響的大腦損害[3-4]。腦深部血腫（即位于腦皮質下 3cm 以上的顱內血腫開顱清除的死亡率較高，然而隨著神經內鏡和止血劑的發展，手術清除深部血腫比以前更安全，創傷更小[5]。微創手術在治療腦深部血腫方面具有很大的潛力，并可能改善患者預后[6-7]。多模態影像融合技術是醫學影像的技術突破，可將通過不同影像檢查方法得到的影像資料進行融合重建，經處理后形成一種具有綜合信息的圖像，提取出更準確、全面、可靠的信息使顱骨、正常腦組織、病變等在同一圖像中呈現出來[8]，可提供準確信息來輔助醫師進行疾病診斷和分類，提高診斷準確率，該技術對術前精準定位、手術方案的制定及入路選擇具有重大意義。神經內窺鏡技術的發展使手術通道更小，視野好，有利于治療深部血腫，且不提高并發癥發生率[7，9-10]。本研究回顧性分析 2018年1月1日—2022年12月31日在阜陽市人民醫院神經外科行手術治療的65例丘腦出血患者，旨在研究微創穿刺術（即多模態神經導航3D打印術 + 神經內鏡手術）與常規開顱術的手術效果及預后比較，探討更適合腦深部血腫的手術方式。……