本文關(guān)鍵詞：無框架立體定向穿刺技術(shù)治療功能區(qū)腦膿腫　出處：《揚州大學》2014年碩士論文　論文類型：學位論文

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【摘要】：目的：探討無框架立體定向穿刺技術(shù)在治療功能區(qū)腦膿腫的優(yōu)勢及臨床診斷治療過程中的注意事項,提高功能區(qū)腦膿腫的臨床治療水平。 方法：對揚州市第一人民醫(yī)院神經(jīng)外科自2012年12月至2013年5月收治的3例顱內(nèi)占位的患者進行治療。三例患者術(shù)前均行頭顱MRI平掃+增強提示邊緣強化的囊性病變,高度懷疑腦膿腫。術(shù)前1天頭部貼Mark后均行MRI層厚3mm的薄層掃描；麻醉后按照患者病變位置擺放合適手術(shù)體位；安裝由南京麥迪柯公司生產(chǎn)的MD-2000A1型立體定向手術(shù)系統(tǒng)(無框架掃描腦立體定向手術(shù)系統(tǒng))的專用頭架；并將術(shù)前的MRI薄層圖像導(dǎo)入計算機工作站與手術(shù)計劃系統(tǒng),根據(jù)工作站的圖像融合結(jié)果確定病灶靶點,避開功能區(qū)及重要的血管神經(jīng)確定入顱點、穿刺路徑及深度；依據(jù)穿刺路徑確定手術(shù)切口,頭皮切開并顱骨鉆孔,選擇合適的系統(tǒng)自帶穿刺針進行穿刺,有突破感后用5ml注射器進行抽吸濃液并沖洗維持適當膿腫腔液體張力,拔出穿刺針更換硅膠引流管,再次沖洗,并戳孔引出接引流瓶,縫扎可靠固定,術(shù)后予以抗感染及支持對癥治療,進行頭顱CT復(fù)查,術(shù)后1月、3月分別行頭顱MRI復(fù)查,并對隨訪結(jié)果進行分析。 結(jié)果：3例患者穿刺均一次性成功,分別抽出膿性液體進行培養(yǎng)、涂片,僅1例培養(yǎng)陽性,1例涂片為革蘭陽性球菌,1例涂片為大量中性粒細胞。3例患者中1例術(shù)后膿腫未明顯減少,行再次穿刺外引流后治愈。3例患者4次手術(shù)時間分別為1.5h,1h,1.5h,0.5h,平均1.1h。術(shù)后未出現(xiàn)手術(shù)并發(fā)癥及神經(jīng)功能缺失癥狀,原有神經(jīng)功能障礙明顯好轉(zhuǎn),治愈出院。出院后隨訪行影像學檢查,膿腫腔均消失,隨訪時間分別為15月,13月,10月,未見復(fù)發(fā)。 結(jié)論：無框架立體定向穿刺技術(shù)具有操作簡單,穿刺準確,手術(shù)時間短,術(shù)后并發(fā)癥少,安全性高,可以反復(fù)穿刺等優(yōu)點,是治療腦膿腫特別是功能區(qū)腦膿腫的重要手術(shù)方式；對于術(shù)前高度懷疑的腦膿腫患者,無框架立體定向穿刺技術(shù)可以在明確診斷的同時進行抽吸治療；無框架立體定向穿刺技術(shù)對于功能區(qū)腦膿腫患者解除腦壓迫、緩解癥狀、恢復(fù)功能具有重要意義。
[Abstract]:Objective: to explore the advantages of frameless stereotactic puncture in the treatment of brain abscess in functional area and the points for attention in clinical diagnosis and treatment, and to improve the clinical treatment level of brain abscess in functional area. Methods: from December 2012 to May 2013, 3 patients with intracranial space occupying were treated in the neurosurgery department of the first people's Hospital of Yangzhou. All three patients underwent MRI scan before operation. Contrast enhancement suggests marginal enhancement of cystic lesions. The brain abscess was highly suspected. After Mark was applied to the head 1 day before operation, the thin layer scanning of MRI layer thickness of 3 mm was performed. After anesthesia, according to the pathological position of the patients, the proper position of the operation was placed. Installing the special head frame of the MD-2000A1 stereotactic surgery system (frameless scan brain stereotactic surgery system) produced by Nanjing Medica Company; The thin MRI images were imported into the computer workstation and the operation planning system. According to the image fusion results of the workstation, the focus targets were determined, and the cranial sites were determined by avoiding the functional areas and important vessels and nerves. Puncture path and depth; According to the puncture path to determine the surgical incision, scalp incision and skull drilling, select the appropriate system with the puncture needle for puncture. After a breakthrough, a 5ml syringe was used to draw the concentrated liquid and wash and maintain the proper liquid tension of the abscess cavity. The puncture needle was pulled out to replace the silica gel drainage tube, then flushed again, and the hole was poked out to lead to the drawing bottle, and the suture was reliably fixed. MRI was performed on January and March, and the follow-up results were analyzed. Results all of the 3 cases were successfully punctured and cultured with purulent fluid. Only 1 case was positive for culture and 1 case was Gram-positive cocci. One case was smeared with a large number of neutrophilic granulocytes, 1 case had no obvious decrease of abscess after operation, and 3 cases were cured after re-puncture and drainage for 1.5 h or 1.5 h respectively. 0.5 h, average 1.1 h. There were no postoperative complications and neurological deficit symptoms. The original neurological dysfunction was obviously improved and was cured and discharged. After discharge, the abscess cavity disappeared. The follow-up time was 15 months, 13 months and October, respectively. No recurrence was found. Conclusion: frameless stereotactic puncture has the advantages of simple operation, accurate puncture, short operation time, less postoperative complications, high safety and so on. It is an important operative method for the treatment of brain abscess, especially the brain abscess in the functional area. For preoperatively highly suspected brain abscess patients, frameless stereotactic puncture technique can be used to treat the brain abscess at the same time of definite diagnosis. Frameless stereotactic puncture plays an important role in relieving brain compression, relieving symptoms and restoring function in patients with functional brain abscess.
【學位授予單位】：揚州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R651.1

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