本文選題：神經(jīng)導(dǎo)航　切入點(diǎn)：磁共振彌散張量成像　出處：《新鄉(xiāng)醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：背景 近年來計(jì)算機(jī)技術(shù)迅猛發(fā)展,神經(jīng)導(dǎo)航系統(tǒng)可以對各種圖像數(shù)據(jù)進(jìn)行融合；神經(jīng)導(dǎo)航系統(tǒng)已經(jīng)由單純解剖導(dǎo)航向功能導(dǎo)航方向發(fā)展。通過對多種影像資料的融合,多模態(tài)神經(jīng)導(dǎo)航可以在術(shù)前合理規(guī)劃手術(shù)切口及入路避開重要功能結(jié)構(gòu),術(shù)中對腦腫瘤及鄰近重要功能結(jié)構(gòu)進(jìn)行實(shí)時(shí)監(jiān)測,實(shí)現(xiàn)最大程度切除腫瘤并最小限度損傷神經(jīng)功能。2012年中國人民解放軍第一五三醫(yī)院引進(jìn)BrainLAB多模態(tài)神經(jīng)導(dǎo)航系統(tǒng)。 目的 探討多模態(tài)神經(jīng)導(dǎo)航手術(shù)與傳統(tǒng)手術(shù)在治療中央?yún)^(qū)腦腫瘤各環(huán)節(jié)的差異；并比較兩者對神經(jīng)功能的保護(hù)。 資料和方法 1研究對象 經(jīng)醫(yī)院倫理委員會同意,回顧性分析鄭州市解放軍第153中心醫(yī)院2009-2013年收治的中央?yún)^(qū)顱腦腫瘤患者共64例。年齡14-73歲,其中男性35例,女性29例。病理結(jié)果顯示：膠質(zhì)瘤40例,腦膜瘤16例,轉(zhuǎn)移癌2例,海綿狀血管瘤3例,腦膿腫1例,病理性鈣化2例。 2分組方法 依據(jù)相關(guān)治療開展時(shí)間不同分為電生理組33例,神經(jīng)導(dǎo)航組31例。電生理組病例按照傳統(tǒng)解剖學(xué)定位方式標(biāo)記手術(shù)切口,術(shù)中實(shí)施皮層及皮層下電刺激保護(hù)重要神經(jīng)功能結(jié)構(gòu)。神經(jīng)導(dǎo)航組術(shù)前重建3D解剖結(jié)構(gòu)、描繪腫瘤范圍并行纖維束示蹤,評估手術(shù)風(fēng)險(xiǎn),在計(jì)劃工作站上設(shè)計(jì)手術(shù)切口及入路,術(shù)中執(zhí)行皮層電刺激保護(hù)運(yùn)動(dòng)區(qū)皮層,導(dǎo)航圖像實(shí)時(shí)引導(dǎo)切除腫瘤皮層下部分保護(hù)纖維束而不進(jìn)行皮層下電刺激。術(shù)后1月對所有病例進(jìn)行神經(jīng)功能及切除程度評估。 3統(tǒng)計(jì)學(xué)分析 采用SPSS17.0統(tǒng)計(jì)學(xué)軟件處理,計(jì)量資料采用t檢驗(yàn),計(jì)數(shù)資料采用x2檢驗(yàn),設(shè)定α=0.05為檢驗(yàn)水準(zhǔn),P0.05有統(tǒng)計(jì)學(xué)意義。 結(jié)果 導(dǎo)航組全切除27例,次全切除2例,大部切除1例,部分切除1例,全切率87.1%；電生理組全切除19例,次全切除9例,大部切除3例,部分切除1例,全切率57.6%。,兩組差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。手術(shù)前后KPS評分比較,Kpost電(83.94±7.04)與Kpre電(79.70±12.12)比較,t值2.235,差異有統(tǒng)計(jì)學(xué)意義(配對t檢驗(yàn),P0.05)。Kpost導(dǎo)(89.03±7.00)與Kpre電(79.68±10.80)比較,t值5.609,差異有統(tǒng)計(jì)學(xué)意義(配對t檢驗(yàn),P0.05)。手術(shù)前后KPS評分變化量比較,△KPS導(dǎo)(9.35±9.29)與△KPS電(4.24±10.91)比較,t值2.013,差異有統(tǒng)計(jì)學(xué)意義(獨(dú)立樣本t檢驗(yàn),P0.05)。電生理組手術(shù)時(shí)間(153.26±27.50min)與導(dǎo)航組手術(shù)時(shí)間(130.38±27.92min),t值3.220,差異有統(tǒng)計(jì)學(xué)意義(獨(dú)立樣本t檢驗(yàn),P0.05)。 結(jié)論 1、應(yīng)用神經(jīng)導(dǎo)航系統(tǒng)可以在手術(shù)前合理設(shè)計(jì)手術(shù)切口與入路；2、術(shù)中應(yīng)用神經(jīng)導(dǎo)航進(jìn)行纖維束示蹤,可以對大腦功能結(jié)構(gòu)進(jìn)行預(yù)判,指導(dǎo)術(shù)中電刺激操作并準(zhǔn)確定位病變位置；3、神經(jīng)導(dǎo)航應(yīng)用于臨床,能提高中央?yún)^(qū)腦腫瘤的全切率,降低術(shù)后神經(jīng)功能障礙的發(fā)生率。
[Abstract]:Background. In recent years, with the rapid development of computer technology, the neural navigation system can fuse all kinds of image data, and the neural navigation system has been developed from anatomic navigation to functional navigation. Multimodal neuronavigation can reasonably plan surgical incision and approach before operation to avoid important functional structures, and monitor brain tumors and adjacent important functional structures in real time. The BrainLAB multimodal neuronavigation system was introduced into the 153 Hospital of the Chinese people's Liberation Army in 2012. Purpose. To explore the differences between multimodal neuronavigation and traditional operation in the treatment of brain tumors in central region, and to compare the protection of nerve function between them. Information and methodology. 1 object of study. With the consent of the Hospital Ethics Committee, 64 patients with craniocerebral tumors in the Central District, aged 14-73 years, admitted to the 153 Central Hospital of the people's Liberation Army of Zhengzhou from 2009 to 2013, were retrospectively analyzed, including 35 males and 29 females. The pathological results showed that 40 cases were gliomas. There were 16 cases of meningioma, 2 cases of metastatic carcinoma, 3 cases of cavernous hemangioma, 1 case of brain abscess and 2 cases of pathological calcification. 2 grouping method. According to the time of related treatment, the patients were divided into electrophysiological group (n = 33) and neuronavigation group (n = 31). The nerve navigation group reconstructed 3D anatomical structure before operation, described the tumor area and tracer of fiber bundle, evaluated the operation risk, designed the surgical incision and approach on the plan workstation. Intraoperative electrical stimulation was performed to protect the motor cortex, and navigation images were used to guide the removal of subcortical protective fibers instead of subcortical electrical stimulation. On January, the neurologic function and the degree of resection were evaluated in all patients. 3Statistical analysis. The SPSS17.0 software was used to process the data, the measurement data was t-test, the count data was x2 test, and the test level of 偽 -0. 05 was significantly higher than that of the control group (P0.05). Results. In the navigation group, there were 27 cases of total resection, 2 cases of subtotal resection, 1 case of subtotal resection, 1 case of partial resection, 87.1% of total resection rate, 19 cases of total resection, 9 cases of subtotal resection, 3 cases of subtotal resection and 1 case of partial resection in electrophysiological group. The total resection rate was 57.60.The difference between the two groups was statistically significant (P 0.05). The comparison of KPS scores before and after operation was 83.94 鹵7.04) compared with that of Kpre (79.70 鹵12.12). The difference was statistically significant (paired t test (P 0.05) .Kpost guide 89.03 鹵7.00) and Kpre electricity (79.68 鹵10.80). The difference was significant (P 0.05 鹵7.00) and Kpre (79.68 鹵10.80). Comparison of KPS scores before and after operation, There was significant difference between KPS (9.35 鹵9.29) and KPS (4.24 鹵10.91). The difference was statistically significant (independent sample t test, P 0.05). The operation time of electrophysiology group was 153.26 鹵27.50 minutes, and the operating time of navigation group was 3.220, which was significantly different from that of navigation group (independent sample t test, P 0.05). Conclusion. 1. The application of neuronavigation system can reasonably design the incision and approach before the operation, and the nerve navigation can be used to trace the fiber bundle during the operation, and the functional structure of the brain can be forecasted. In order to guide the operation of intraoperative electrical stimulation and accurately locate the location of the lesion, neuronavigation can improve the total resection rate of brain tumors in the central region and reduce the incidence of postoperative neurological dysfunction.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.41

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