發(fā)布時(shí)間：2018-06-06 11:20

  本文選題：神經(jīng)導(dǎo)航 + 神經(jīng)電生理��； 參考：《石河子大學(xué)》2017年碩士論文

【摘要】：目的:研究觀察神經(jīng)導(dǎo)航聯(lián)合術(shù)中神經(jīng)電生理監(jiān)測運(yùn)用于幕上病變顯微切除的可行性、安全性及近期臨床療效。方法:對我院神經(jīng)外科2013年1月至2016年6月手術(shù)治療的幕上病變患者的臨床資料進(jìn)行回顧性分析,選擇其中使用神經(jīng)導(dǎo)航及術(shù)中電生理監(jiān)測輔助技術(shù)的首次經(jīng)手術(shù)治療的患者共33例作為研究組,選擇同等數(shù)量的僅在顯微鏡下切除的幕上病變患者為對照組。觀察比較兩組術(shù)后骨窗最大徑與術(shù)前同層面病變最大徑之差,術(shù)中持續(xù)時(shí)間、術(shù)中出血量,術(shù)后住院時(shí)長,病變切除程度,術(shù)后癥狀緩解情況,術(shù)后并發(fā)癥及術(shù)后隨訪近期預(yù)后及復(fù)發(fā)情況。結(jié)果:研究組和對照組患者年齡、性別、病理類型、病變位置、病變大小、術(shù)前KPS評分等均無統(tǒng)計(jì)學(xué)差異。研究組術(shù)后骨窗最大徑與術(shù)前同層面病變最大徑之差為22.94±13.64mm,對照組術(shù)后骨窗最大徑與術(shù)前同層面病變最大徑之差為32.33±12.34mm;兩組差異有統(tǒng)計(jì)學(xué)意義(p0.05)。研究組術(shù)中出血量平均為220.15±144.93ml,手術(shù)持續(xù)時(shí)間平均為222.48±60.52min,術(shù)后住院時(shí)間平均為16.88±9.36日,與對照組進(jìn)行比較術(shù)中出血、術(shù)后住院時(shí)長差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。研究組全切27例,次全切3例,大部分切除2例,部分切除1例,全切率為81.82%;對照組全切18例,次全切9例,大部分切除4例,部分切除2例,全切率54.55%;兩組差異明顯有統(tǒng)計(jì)學(xué)意義(p0.05)。研究組術(shù)前KPS評分平均為75.45±22.91,出院前KPS評分平均為88.79±18.16,術(shù)后3月KPS評分為89.09±19.90;對照組術(shù)前KPS評分平均為71.21±26.55,出院前KPS評分平均為74.24±29.69,術(shù)后3月KPS評分為68.48±35.98;出院前、術(shù)后3月KPS評分兩組比較差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。使用了神經(jīng)導(dǎo)航聯(lián)合電生理技術(shù)對于術(shù)后癥狀改善及近期并發(fā)癥的發(fā)生率有明顯改善,且差異有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:聯(lián)合使用神經(jīng)導(dǎo)航技術(shù)及術(shù)中神經(jīng)電生理檢測技術(shù)輔助切除幕上病變安全、可行;聯(lián)合使用神經(jīng)導(dǎo)航技術(shù)及術(shù)中神經(jīng)電生理檢測技術(shù)能縮小骨窗并準(zhǔn)確定位病變,提高幕上病變手術(shù)切除的全切率,尤其是腦膜瘤;術(shù)中能明顯減少術(shù)中出血、縮短術(shù)后住院時(shí)長;術(shù)后能明顯改善患者癥狀及降低并發(fā)癥發(fā)生。
[Abstract]:Objective: to study the feasibility, safety and clinical effect of intraoperative nerve electrophysiological monitoring combined with neuronavigation in microresection of supratentorial lesions. Methods: the clinical data of patients with supratentorial diseases treated by neurosurgery from January 2013 to June 2016 were retrospectively analyzed. A total of 33 patients who were treated with neuronavigation and intraoperative electrophysiological monitoring were selected as the study group, and the same number of patients with supratentorial diseases were selected as the control group. The difference of the maximum diameter of bone window between the two groups before and after operation, the duration of operation, the amount of intraoperative bleeding, the length of hospitalization after operation, the degree of resection of lesion and the relief of postoperative symptoms were observed and compared between the two groups. Postoperative complications, short-term prognosis and recurrence after follow-up. Results: there were no significant differences in age, sex, pathological type, lesion location, lesion size and preoperative KPS score between the study group and the control group. The difference between the two groups was 22.94 鹵13.64mm and 32.33 鹵12.34mm respectively. The difference between the two groups was statistically significant (p 0.05). The average amount of intraoperative bleeding was 220.15 鹵144.93 ml, the mean duration of operation was 222.48 鹵60.52 min, and the average postoperative hospitalization time was 16.88 鹵9.36 days. Compared with the control group, the mean intraoperative bleeding was 220.15 鹵144.93 ml, the average duration of operation was 222.48 鹵60.52 min, and the length of hospitalization was significantly different from that of the control group (P 0.05). In the study group, there were 27 cases of total resection, 3 cases of subtotal resection, 2 cases of partial resection, and 1 case of partial resection, with a total resection rate of 81.82%, while in the control group, 18 cases had total resection, 9 cases had subtotal resection, 4 cases had partial resection, 2 cases had partial resection. The total cutting rate was 54.55, and the difference between the two groups was statistically significant (P 0.05). The mean preoperative KPS score was 75.45 鹵22.91, the average KPS score before discharge was 88.79 鹵18.16, the KPS score was 89.09 鹵19.90 3 months after discharge, the average KPS score was 71.21 鹵26.55 in the control group, the average KPS score before discharge was 74.24 鹵29.69, and the KPS score before discharge was 68.48 鹵35.98. There was significant difference in KPS score between the two groups 3 months after operation (P 0.05). The use of neuronavigation combined with electrophysiologic techniques significantly improved the postoperative symptoms and the incidence of recent complications, and the difference was statistically significant (P 0.05). Conclusion: the combined use of neuronavigation and intraoperative nerve electrophysiological examination is safe and feasible for the resection of supratentorial lesions, and the combined use of neuronavigation and intraoperative nerve electrophysiological detection can reduce the bone window and accurately locate the lesion. To improve the total resection rate of supratentorial lesions, especially meningioma; to reduce intraoperative bleeding, shorten the length of postoperative hospital stay; postoperative can significantly improve the symptoms of patients and reduce the incidence of complications.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.1

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