CAJ | 학술논문

目的研制适用于多种规格神经工作内镜的透明导管鞘,并探讨该透明导管鞘在神经内镜手术中的应用价值.方法收集自2010年8月至2013年2月南方医科大学南方医院神经外科运用自制设计的透明导管鞘辅助神经内镜手术治疗的患者68例,术前采用CT和(或)MRI对穿刺部位进行定位,穿刺前透明鞘头固定在内镜头上,固定后的鞘头和内镜共同插入透明鞘管内,然后根据术前定位直视下进行目标穿刺,术中随时观察术区周围情况.结果使用自制设计的透明导管鞘做侧脑室前角穿刺48例,其中46例(95.83％)一次穿刺成功.10例脑内血肿用CT影像定位后,在透明导管鞘直视下快速找到并穿刺到血肿腔中,并在透明导管鞘内安全碎吸血肿.3例透明隔囊肿和1例室间孔闭塞利用透明导管鞘直接造瘘和再通成功.结论自制设计的透明导管鞘可在直视下高效地将神经内镜置入侧脑室、囊肿和血肿中,并可提供导管鞘周围及穿刺方向上清晰的手术视野,能明确分辨血肿、脑组织以及血肿的剩余量,是一种安全有效并值得推广应用的神经内镜手术新器械.
목적 연제괄용우다충규격신경공작내경적투명도관초,병탐토해투명도관초재신경내경수술중적응용개치.방법 수집자2010년8월지2013년2월남방의과대학남방의원신경외과운용자제설계적투명도관초보조신경내경수술치료적환자68례,술전채용CT화(혹)MRI대천자부위진행정위,천자전투명초두고정재내경두상,고정후적초두화내경공동삽입투명초관내,연후근거술전정위직시하진행목표천자,술중수시관찰술구주위정황.결과 사용자제설계적투명도관초주측뇌실전각천자48례,기중46례(95.83％)일차천자성공.10례뇌내혈종용CT영상정위후,재투명도관초직시하쾌속조도병천자도혈종강중,병재투명도관초내안전쇄흡혈종.3례투명격낭종화1례실간공폐새이용투명도관초직접조루화재통성공.결론 자제설계적투명도관초가재직시하고효지장신경내경치입측뇌실、낭종화혈종중,병가제공도관초주위급천자방향상청석적수술시야,능명학분변혈종、뇌조직이급혈종적잉여량,시일충안전유효병치득추엄응용적신경내경수술신기계.
Objective To develop a newly transparent sheath and explore the application value of the sheath in neuroendoscopic intra-axial surgery Methods Sixty-eight patients,admitted to our hospital from August 2010 to February 2013,underwent endoscopic surgery with the help of new sheath.Pre-operated CT or MRI were performed to locate the puncture direction;the transparent sheath was used to provide a trajectory in the brain parenchyma,and offer the clear vision surround the sheath tube and the puncture direction.Results Forty-eight patients adopted lateral ventricle anterior horn approach and 46 (95.83％) achieved lesions in the first puncture.Three patients with septum pellucidum cyst and one with Monro obstruction were successfully received the cystic wall fenestration or recanalization with the sheath directly.After the entry point were determined with CT in 10 intracerebral hematoma,the sheath was inserted into the hemorrhage cavity simply and easily;and a smash-suction tube was inserted to evacuate the hematoma safely.Conclusion The transparent sheath can be inserted into lateral ventricle,hemorrhage cavity or cyst efficiently,and provide perfect surgical vision around the sheath and the puncture direction to estimate the brain parenchyma,hemorrhage cavity or the hemorrhage remains;therefore,this transparent sheath,as a safely neuroendoscopic intra-axial surgical instrument,is deserved to be spread.