一种新型脑牵开器在临床中的应用
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摘要
目的研究NY型管状脑牵开器在脑深部开颅手术中的应用。方法回顾性分析53例开颅手术病人的临床资料,按病种分为高血压性脑出血组(脑出血组)29例和脑肿瘤组24例,按治疗方式每组再分为脑牵开器组和对照组。脑牵开器组术中采用NY型管状脑牵开器牵拉,对照组采用传统脑压板牵拉。术后分别对两组肿瘤切除率、血肿清除率、GOS评分及KPS评分进行统计分析。结果脑肿瘤组中,脑牵开器组与对照组肿瘤切除率差异无统计学意义(P>0.05),而前者术后KPS评分明显优于后者(P<0.05);脑出血组中,脑牵开器组与对照组血肿清除率差异无统计学意义,而前者术后GOS评分更优(P<0.05)。两组病例中,脑牵开器组并发症发生率均明显低于对照组(P<0.05)。结论在脑深部病变开颅手术中,采用NY型管状脑牵开器术后并发症少,预后好,且使用简易方便,值得推广。
Objective To study the application of NY-type tubular brain retractor in craniotomy for deep brain lesions. Methods Clinical data of 53 patients undergoing craniotomy were analyzed retrospectively, and the patients were divided into hypertensive cerebral hemorrhage(HCH) group(n = 29) and brain tumor group(n = 24) based on the disease categories. Then each group was subdivided into brain retractor group and control group. NY-type tubular brain retractors were used in the brain retractor group, while traditional brain retractors were used in the control group. The tumor resection rate, hematoma evacuation rate, GOS Scores and KPS Scores were compared postoperatively between the two groups. Results In brain tumor group, there was no significant difference in tumor resection rate between the brain retractor group and control group(P > 0.05), while the former group had better postoperative KPS scores(P < 0.05). In HCH group, there was no significant difference in hematoma evacuation rate between the brain retractor group and control group(P > 0.05), but the former group had better GOS scores(P < 0.05). And the incidence rates of complications in the brain retractor subgroup were lower than those in the control group respectively in the HCH group and the brain tumor group(P < 0.05).Conclusions The NY-type tubular brain retractor has fewer postoperative complications and better prognosis in craniotomy for deep brain lesions, and its operation is easy and convenient, being worth to be popularized in clinical application.
Objective To study the application of NY-type tubular brain retractor in craniotomy for deep brain lesions. Methods Clinical data of 53 patients undergoing craniotomy were analyzed retrospectively, and the patients were divided into hypertensive cerebral hemorrhage(HCH) group(n = 29) and brain tumor group(n = 24) based on the disease categories. Then each group was subdivided into brain retractor group and control group. NY-type tubular brain retractors were used in the brain retractor group, while traditional brain retractors were used in the control group. The tumor resection rate, hematoma evacuation rate, GOS Scores and KPS Scores were compared postoperatively between the two groups. Results In brain tumor group, there was no significant difference in tumor resection rate between the brain retractor group and control group(P > 0.05), while the former group had better postoperative KPS scores(P < 0.05). In HCH group, there was no significant difference in hematoma evacuation rate between the brain retractor group and control group(P > 0.05), but the former group had better GOS scores(P < 0.05). And the incidence rates of complications in the brain retractor subgroup were lower than those in the control group respectively in the HCH group and the brain tumor group(P < 0.05).Conclusions The NY-type tubular brain retractor has fewer postoperative complications and better prognosis in craniotomy for deep brain lesions, and its operation is easy and convenient, being worth to be popularized in clinical application.
引文
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[3]ROSS D A.A simple stereotactic retractor for use with the Leksell stereotactic system[J].Neurosurgery,1993,32(3):475-476.
[4]GREENBERG I M.Self-retaining retractor and handrest system for neurosurgery[J].Neurosurgery,1981,8(2):205-208.
[5]BEEMS T,VAN DONGEN R T.Use of a tubular retractor system as a minimally invasive technique for epidural plate electrode placement under local anesthesia for spinal cord stimulation:technical note[J].Neurosurgery,2006,58(1Suppl):ONS-E177.
[6]魏继武,骆太顺,兰蒙,等.蛇型脑牵开器引起急性硬膜外血肿1例报告[J].中国微侵袭神经外科杂志,1997,2(2):124.
[7]ALMENAWER S A,CREVIER L,MURTY N,et al.Minimal access to deep intracranial lesions using a serial dilatation technique:case-series and review of brain tubular retractor systems[J].Neurosurg Rev,2013,36(2):321-330.
[8]YADAV Y R,YADAV S,SHEREKAR S,et al.A new minimally invasive tubular brain retractor system for surgery of deep intracerebral hematoma[J].Neurol India,2011,59(1):74-77.
[9]GREENFIELD J P,COBB W S,TSOURIS A J,et al.Stereotactic minimally invasive tubular retractor system for deep brain lesions[J].Neurosurgery,2008,63(4 Suppl 2):334-340.
[10]RAZA S M,RECINOS P F,AVENDANO J,et al.Minimally invasive trans-portal resection of deep intracranial lesions[J].Minim Invasive Neurosurg,2011,54(1):5-11.
[11]RECINOS P F,RAZA S M,JALLO G I,et al.Use of a minimally invasive tubular retraction system for deep-seated tumors in pediatric patients[J].J Neurosurg Pediatr,2011,7(5):516-21.
[12]熊涛,王苟思义,陈晓宇,等.神经导航结合管状脑牵开器切除侧脑室脑膜瘤的显微手术疗效分析[J].中华神经外科杂志,2015,31(4):332-336.
[2]OTSUKI T,JOKURA H,YOSHIMOTO T.Stereotactic guiding tube for open-system endoscopy:a new approach for the stereotactic endoscopic resection of intra-axial brain tumors[J].Neurosurgery,1990,27(2):326-330.
[3]ROSS D A.A simple stereotactic retractor for use with the Leksell stereotactic system[J].Neurosurgery,1993,32(3):475-476.
[4]GREENBERG I M.Self-retaining retractor and handrest system for neurosurgery[J].Neurosurgery,1981,8(2):205-208.
[5]BEEMS T,VAN DONGEN R T.Use of a tubular retractor system as a minimally invasive technique for epidural plate electrode placement under local anesthesia for spinal cord stimulation:technical note[J].Neurosurgery,2006,58(1Suppl):ONS-E177.
[6]魏继武,骆太顺,兰蒙,等.蛇型脑牵开器引起急性硬膜外血肿1例报告[J].中国微侵袭神经外科杂志,1997,2(2):124.
[7]ALMENAWER S A,CREVIER L,MURTY N,et al.Minimal access to deep intracranial lesions using a serial dilatation technique:case-series and review of brain tubular retractor systems[J].Neurosurg Rev,2013,36(2):321-330.
[8]YADAV Y R,YADAV S,SHEREKAR S,et al.A new minimally invasive tubular brain retractor system for surgery of deep intracerebral hematoma[J].Neurol India,2011,59(1):74-77.
[9]GREENFIELD J P,COBB W S,TSOURIS A J,et al.Stereotactic minimally invasive tubular retractor system for deep brain lesions[J].Neurosurgery,2008,63(4 Suppl 2):334-340.
[10]RAZA S M,RECINOS P F,AVENDANO J,et al.Minimally invasive trans-portal resection of deep intracranial lesions[J].Minim Invasive Neurosurg,2011,54(1):5-11.
[11]RECINOS P F,RAZA S M,JALLO G I,et al.Use of a minimally invasive tubular retraction system for deep-seated tumors in pediatric patients[J].J Neurosurg Pediatr,2011,7(5):516-21.
[12]熊涛,王苟思义,陈晓宇,等.神经导航结合管状脑牵开器切除侧脑室脑膜瘤的显微手术疗效分析[J].中华神经外科杂志,2015,31(4):332-336.