目的 探討術前腫瘤三維重建用于幕上凸面腦腫瘤開顱術定位的準確性，為開顱手術提供一種精準、安全的輔助方法。方法前瞻性納入2018年4月－2020年11月四川大學華西醫院宜賓醫院神經外科收治的幕上凸面腦腫瘤患者，隨機分入重建組和對照組。重建組采用術前腫瘤三維重建進行開顱術定位，對照組采用傳統二維斷層影像進行開顱術定位。比較兩組患者的基礎情況、術中定位及腫瘤暴露情況滿意率、骨窗最大直徑、手術時間、腦引流靜脈損傷情況和術后皮下積液或顱內感染發生情況。結果共納入43例患者，重建組22例，對照組21例。兩組患者的年齡、性別構成、中線移位發生率、腫瘤生長部位和腫瘤大小差異均無統計學意義（P>0.05）。兩組患者的腦引流靜脈損傷發生率和術后皮下積液或顱內感染發生率差異無統計學意義（P>0.05）。重建組的術中定位及腫瘤暴露情況滿意率（95.5% vs. 66.7%）高于對照組，骨窗最大直徑［（6.26±1.32）vs.（7.31±1.13）cm］和手術時間［（194.00±22.76）vs.（214.57±26.53）min］低于對照組，差異均有統計學意義（P<0.05）。結論 采用術前三維重建有助于更精確地定位腫瘤，提高腫瘤暴露滿意率，縮小開顱骨窗直徑，縮短手術時間，與傳統的二維斷層影像定位相比更具有優勢。
【摘要】 目的 探討中型和重型顱腦損傷后患者血小板（platelet，Plt）參數的變化特點及臨床意義。 方法 選取2009年3月-2010年3月腦外傷后24 h內入院的顱腦損傷患者75例作為觀察組，于傷后1、3、7、14 d采血測定Plt數量、血小板平均體積（mean platelet volume，MPV）、血小板體積分布寬度（platelet distribution width，PDW），并同時進行格拉斯哥昏迷評分（Glasgow coma scale，GCS）。同時選取60例健康體檢者，測定Plt、MPV和PDW作為對照組。 結果 觀察組傷后1、3、7 d Plt計數分別為（106.21±36.31）、（102.76±35.23）、（108.37±31.32）×109/L，較對照組[（210.41±68.56）×109/L]明顯降低（Plt;0.05）；觀察組傷后1、3、7 d MPV分別為（12.34±1.34）、（11.21±1.52）、（10.78±1.36） fL，PDW分別為（15.78±1.26）、（17.67±1.16）、（16.72±1.21） fL，均較對照組[MPV：（8.24±1.76） fL，PDW：（12.86±1.42） fL]明顯升高（Plt;0.05）；傷后14 d Plt、MPV和PDW均較對照組差異無統計學意義（Pgt;0.05）。GCS≤8分組傷后1 d Plt計數為（96.85±36.52）×109/L，明顯低于GCSgt;8分組[（123.85±35.78）×109/L]，而GCS≤8分組MPV為（12.14±1.32） fL，PDW為（18.63±1.21） fL，均明顯高于GCSgt;8分組[MPV：（9.78±1.34） fL，PDW：（16.72±1.34） fL]，差異均有統計學意義（Plt;0.05）。傷后第1天Plt與隨訪6個月GOS評分呈正相關（r=0.625，Plt;0.05）。 結論 中型和重型顱腦損傷后Plt計數明顯降低，MPV和PDW值明顯升高，且與傷情及預后有關。Plt及其參數的檢測有助于對傷情、預后的判斷。【Abstract】 Objective To investigate the platelet parameters changes and its clinical significance in medium and severe head injury patients. Methods From March 2009 to March 2010, 75 brain injury patients hospitalized within 24 h after injury were included in this study. The platelet number (Plt), mean platelet volume (MPV), platelet volume distribution width (PDW) and Glasgow coma scale were measured on the first, third, seventh and fourteenth day after injury respectively. We also measured the Plt, MPV and PDW of 60 healthy volunteers to make comparisons. Results The Plt counts were (106.21±36.31), (102.76±35.23), and (108.37±31.32)×109/L in the head injury patients on the first, third, and 7th day respectively, which were significantly lower than those in the control group [(210.41±68.56)×109/L] (Plt;0.05); the MPV and PDW values measured on the first day [MPV: (12.34±1.34) fL, PDW: (15.78±1.26) fL] and the third day [MPV: (11.21±1.52) fL, PDW: (17.67±1.16)fL] were both significantly lower than those of the control group (Plt;0.05); There was no evidence of a difference in Plt, MPV and PDW between the two groups fourteen day after injury (P＞0.05); The Plt count was (96.85±36.52)×109/L in GCS≤8 group on the first day, which was significantly lower than that of GCSgt;8 group [(123.85±35.78) fL, Plt;0.05]; However, the MPV and PDW values in GCS≤8 group [(MPV: (12.14±1.32) fL, PDW: (18.63±1.21) fL] were both significantly higher than those of GCSgt;8 group [MPV: (9.78±1.34) fL, PDW: (16.72±1.34) fL, Plt;0.05]; The Plt count was correlated with GOS score positively (r=0.625,Plt;0.05). Conclusions Medium and severe head injury patients are significantly associated with a lower Plt count and increased MPV and PDW values. The Plt parameters changes are correlated with the prognosis of patients. Therefore, the measurement of Plt parameters may contribute to the valuation of severity and prognosis, and provide new ideas for treatment of head injury patients.
