2022 年第 9 期 第 17 卷

3D-slicer软件辅助神经内镜在幕上高血压性脑出血个体化治疗中的应用价值

Application value of 3D-slicer software assisted neuroendoscopy in the individualized treatment of supratentorial hypertensive intracerebral hemorrhage

作者：王文举1蔡强1李知阳1宋平1魏航宇1周龙1雷盼1程利2

英文作者：Wang Wenju1 Cai Qiang1 Li Zhiyang1 Song Ping1 Wei Hangyu1 Zhou Long1 Lei Pan1 Cheng Li2

单位：1武汉大学人民医院神经外科，武汉430060；2武汉大学人民医院东院重症医学科，武汉430060

英文单位：1Department of Neurosurgery Renmin Hospital of Wuhan University Wuhan 430060 China; 2Department of Critical Care East Branch Renmin Hospital of Wuhan University Wuhan 430060 China

关键词：幕上高血压性脑出血；3D-slicer；经颅神经内镜

英文关键词：Supratentorialhypertensiveintracerebralhemorrhage;3D-slicer;Transcranialneuroendoscopy

• 摘要：

• 目的 探讨3D-slicer软件辅助神经内镜个体化治疗幕上高血压性脑出血的临床效果。方法  回顾性分析2020年5月至2021年9月武汉大学人民医院神经外科收治的111例幕上高血压性脑出血患者的临床资料。根据手术方法不同分为3D-slicer组（21例，行3D-slicer软件辅助神经内镜血肿清除术）、CT组（32例，行CT辅助神经内镜血肿清除术）及钻孔组（58例，行血肿钻孔引流术）。对比3组术前定位设计并对3组患者一般资料、术前血肿量和术后评估指标作统计学分析。结果  3组术前一般资料及术前血肿量比较差异均无统计学意义（均P＞0.05）。3D-slicer组术后第1天血肿清除率高于CT组和钻孔组，置管时间短于钻孔组，差异均有统计学意义（均P＜0.05）。3D-slicer组引流管置管准确度高于钻孔组［100.0%（21/21）比77.6%（45/58）］（χ2=4.120，P=0.042）。3D-slicer组手术时间长于钻孔组，差异有统计学意义（P＜0.05）。3D-slicer组与CT组在短期预后出院格拉斯哥昏迷量表评分及脑卒中改良Rankin量表评分方面，差异均无统计学意义（均P＞0.05）；3D-slicer组出院格拉斯哥昏迷量表评分高于钻孔组、脑卒中改良Rankin量表评分低于钻孔组［（12.7±3.6）分比（10.8±2.4）分，（3.2±1.4）分比（3.9±1.2）分］，差异均有统计学意义（均P＜0.05）。结论 3D-slicer软件辅助经颅神经内镜治疗幕上高血压性脑出血在术前设计手术入路方面具有微创、精准、个体化等特点，在整体疗效方面具有一定优势。

• Objective  To investigate the clinical effect of 3D-slicer software assisted neuroendoscopy in the individualized treatment of supratentorial hypertensive intracerebral hemorrhage. Methods  The clinical data of 111 patients with supratentorial hypertensive intracerebral hemorrhage admitted to Department of Neurosurgery, Renmin Hospital of Wuhan University from May 2020 to September 2021 were analyzed retrospectively. According to different surgical approaches, they were divided into 3D-slicer group(21 cases, treated with 3D-slicer software assisted neuroendoscopic hematoma removal), CT group(32 cases, treated with CT assisted neuroendoscopic hematoma removal) and drilling group(58 cases, treated with hematoma drilling and drainage). The preoperative location designs of the three groups were compared, and the general data, preoperative hematoma volume and postoperative evaluation indexes of the three groups were statistically analyzed. Results  There were no significant differences among the three groups in the preoperative general data and preoperative hematoma volume(all P>0.05). The clearance rate of hematoma in 3D-slicer group on the first day after operation was higher than that in CT group and drilling group, and the catheterization time was shorter than that in drilling group(all P<0.05). The accuracy of catheterization in 3D-slicer group was higher than that in drilling group ［100.0% (21/21) vs 77.6% (45/58)］（χ2=4.120, P=0.042）. The operation time of 3D-slicer was longer than that of drilling group, and the difference was statistically significant(P<0.05). There were no significant differences in Glasgow Coma Scale score and stroke modified Rankin Scale score at discharge between 3D-slicer group and CT group(all P>0.05); the Glasgow Coma Scale score at discharge in 3D-slicer group was higher than that in drilling group, and stroke modified Rankin Scale score was lower than that in drilling group［(12.7±3.6) vs (10.8±2.4), (3.2±1.4) vs (3.9±1.2)］(all P<0.05). Conclusions  3D-slicer software assisted transcranial neuroendoscopy in the treatment of supratentorial hypertensive intracerebral hemorrhage has the characteristics by minimally invasive, accurate and individualized, and has certain advantages in the overall efficacy.