[1]罗 强 刘卫平 龙乾发 张胡金 柴 源 苗 宇 伊西才.实时超声联合神经导航监测在颅内肿瘤显微手术中的应用[J].中国临床神经外科杂志,2020,(04):196-198.[doi:10.13798/j.issn.1009-153X.2020.04.002]
 LUO Qiang,LIU Wei-ping,LONG Qian-fa,et al.Applicative value of intraoperative real-time ultrasound combined with neuronavigation to microneurosurgery for intracranial tumors[J].,2020,(04):196-198.[doi:10.13798/j.issn.1009-153X.2020.04.002]
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实时超声联合神经导航监测在颅内肿瘤显微手术中的应用()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2020年04期
页码:
196-198
栏目:
论著
出版日期:
2020-04-30

文章信息/Info

Title:
Applicative value of intraoperative real-time ultrasound combined with neuronavigation to microneurosurgery for intracranial tumors
文章编号:
1009-153X(2020)04-0196-03
作者:
罗 强 刘卫平 龙乾发 张胡金 柴 源 苗 宇 伊西才
710032 西安,空军军医大学西京医院神经外科[罗 强(硕士研究生)、刘卫平、伊西才);710003,西安市中心医院神经外科(罗 强、龙乾发、张胡金、柴 源、苗 宇)
Author(s):
LUO Qiang1 LIU Wei-ping2 LONG Qian-fa1 ZHANG Hu-jin1 CHAI Yuan1 MIAO Yu1 YI Xi-cai2.
1. Department of Neurosurgery, Xi'an Municipal Central Hospital, Xi'an 710003, China; 2. Department of Neurosurgery, Xijing Hospital, Air Force Military Medical University, PLA, Xi'an, 710032, China
关键词:
颅内肿瘤显微手术术中实时超声神经导航疗效
Keywords:
Intraoperative real-time ultrasound Neuronavigation Microneurosurgery Intracranial tumors
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2020.04.002
文献标志码:
A
摘要:
目的 探讨实时超声联合神经导航在颅内肿瘤显微手术中定位及实时监测的作用。方法 筛选空军军医大学西京医院神经外科2014年10月至2016年7月收治的35例术中实时超声监测联合神经导航辅助显微手术切除的颅内肿瘤作为观察组,并以同期35例神经导航引导但未行术中实时超声监测的颅内肿瘤作为对照组。结果 观察组肿瘤全切率[91.42%(32/35)]与对照组[82.85%(29/35)]无明显差异(P<0.05)。观察组手术时间[(284.1±20.58)min]较对照组[(306.5±11.92)min]明显缩短(P<0.05)。术前,观察组KPS评分[(58.74±2.076)分]与对照组[(56.34±1.381)分]无明显差异(P>0.05);术后1周,观察组KPS评分[(83.21±6.217)分]和对照组[(76.49±4.638)分]较术前均明显提高,而且,观察组明显高于对照组(P<0.05)。两组术后均未发生严重并发症(如出血、感染等),围手术期没有死亡病例。术后3个月门诊复查,均未见肿瘤复发。结论 术中超声可精准定位并实时引导,监测肿瘤残余,提高手术效率并最大限度地保护神经功能。
Abstract:
Objective To explore the value of intraoperative real-time ultrasound combined with neuronavigation to microneurosurgery for intracranial tumors. Methods Of 70 patients with intracranial tumors, who were treated in Department of Neurosurgery of Xijing Hospital from October, 2014 to July, 2016, 35(observed group) underwent the microsurgery under the help of intraoperative real-time ultrasound and neuronavigation, and 35(control group)micro neurosurgery only under the help of neuronavigation. The operative duration, hospital stay and curative effects were analyzed and compared between both the groups. Results The timorous location, size and boundaries, peritumorous blood flow and reasonable surgical approach path and depth were found well by intraoperative real-time ultrasound. The rate of total resection of the tumors (91.42%) was significantly higher in the observed group than that (82.85%)in control group(P<0.05). The operative duration and hospital stay were significantly shorter in the observed group than those in the control group (P<0.05). The scores of Karnofsky performance score were significantly higher in the observed group than those in the control group 1 week after the surgery (P<0.05). Conclusions The intraoperative real-time ultrasound is helpful to accurately locating the tumorous boundaries, monitoring residual tumor, improving the operative efficiency and increase in the rate of total removal of tumors in the patients with intracranial tumors, and therefore it is worth of clinically popularizing widely.

参考文献/References:

[1] Unsgaard G, Ommedal S, Muller T, et al. Neuronavigation by intraoperative three-dimensional ultrasound initial expe- rience during brain tumor resection [J]. Neurosurgery, 2002, 50(4): 804-812.
[2] Melada A, Heinrich Z, Chudy D, et al. The difference between ultrasound-guided and stereotactic-guided neuro- surgical procedures [J]. Minim Invasive Neurosurg, 2000, 43: 149-152.
[3] Picarelli H, Delimaoliveira M, Borsengshu E, et al. Intra- operative ultrasonography for presumed brain metastases: a case series study [J]. Arq Neuropsiquiatr, 2012, 70(10): 793-798.
[4] Nimsky C, Ganslandt O, Cemy S, et al. Quantification of vi- sualization of, and compensation for brain shift using intra- opertivemagnetic resonance imaging [J]. Neurosurgery, 2000, 47(6): 1070-1079.
[5] Tirakotai W, Sure U, Benes L, et al. Image-guided transyl- vian, transinsular approach for insular cavernous angiomas [J]. Neruosurgery, 2003, 53(7): 423-430.
[6] Unsgaard G, Rygh OM, Selbekk T, et al. Intraoperative 3D ultrasound in neurosurgery [J]. Acta Neurochir (Wien), 2006, 148(2): 235-253.
[7] 宗志涛,王奇萍,谭政华,等. 术中超声在颅内肿瘤治疗中 的临床应用[J]. 当代医学杂志,2016,32(22):85-86.
[8] Reinacher PC, van Velthoven V. Intraoperaive ultrasound imaging: practical applicability as a real-time navigation system [J]. Acta Neurochir (Wien), 2002, 85(Suppl): 89-93.
[9] Unsgaard G, Gronningsaeter A, Ommedal S, et al. Brain operations guided by real-time two dimensional ultrasound: new possibilities as a result of improved image quality [J]. Neurosurgery, 2002, 51: 402-412.
[10] 李虎年,刘南平,孙海峰,等. 术中实时超声在颅内手术 中的应用价值[J]. 中华临床神经外科杂志,2010,15(5): 307-308.
[11] French LA, Wild JJ, Neal D. Detection of cerebral tumors by ultrasoniv pulses; Pilot studies on postmortem material [J]. Cancer, 1950, 3(3): 705-708.
[12] Lindner D, Trantakis C, Renner C, et al. Application of intraoperative 3D ultrasound during navigated tumor resec- tion [J]. Minim Invasive Neurosurg, 2006, 49(4): 197-202.
[13] 张国臣,赵四军,韩 磊,等. 术中超声联合神经导航应用 于低级别胶质瘤显微手术[J]. 中国医学影像技术,2019, 35(5):655-658.

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备注/Memo

备注/Memo:
通讯作者:刘卫平,E-mail:liuwp@fhmu.edu.cn (2019-07-04收稿,2019-09-14修回)
更新日期/Last Update: 2020-04-10