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

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。

Applicative value of intraoperative real-time ultrasound combined with neuronavigation to microneurosurgery for intracranial tumors

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.