无框架立体定向下抽吸清除重度原发性脑干出血疗效初步分析

目的探讨神经外科手术机器人立体定向治疗重度原发性性脑干出血(PBH)的临床效果。方法回顾性分析2020年11月—2021年4月湖州市南太湖医院经神经外科机器人立体定向下抽吸清除血肿的10例重度原发性脑干出血患者，分析脑干血肿分型与愈后的相关性。结果术中无死亡病例，为期3个月的随访，存活6例，术后并发症死亡1例，放弃治疗死亡3例；根据改良Rankin评分，术后90 d内3分1例，4分3例，5分2例，死亡4例。结论手术机器人无框架立体定向穿刺清除引流重度脑干出血是有效的，明显降低死亡率，0型及1型血肿清除术后患者90 d内死亡率及改良Rankin评分均优于2型及3型血肿，基于立体定向为基础的脑干血肿分型，有利于术前评估治疗效果。

ObjectiveTo investigate the clinical effect of neurosurgery robot stereotaxic in the treatment of severe primary brainstem hemorrhage(PBH). Methods10 patients with severe PBH treated with neurosurgical robotic stereotaxic to evacuate the hematoma who were admitted to Department of Neurosurgery, South Taihu Hospital Affiliated to Huzhou Normal University from November 2020 to April 2021 were analyzed retrospectively. The correlation between the classification of brainstem hematoma and its prognosis were analyzed. ResultsThe hematoma removal effects of 10 cases were satisfactory, and there was no death during the operation. The following up of three months showed 6 survived and one case died of postoperative complications, 3 died after abandon treatment. According to the modified Rankin score, within 90 days after operation, 1 case had three scores, 3 had a score of 4, 2 had a score of 5, and 4 died. ConclusionsThe puncture and suction of surgical robot frameless stereotaxic puncture is effective to clear and drain severe brainstem hemorrhage, which can significantly reduce the mortality rate.In terms of the 90-day mortality rate and modified Rankin score of patients, type 0 and type 1 hematoma are better than those of type 2 and 3 hematoma. Brainstem hematoma classification, based on stereotaxic is conducive to preoperative evaluation of treatment effects.