Objective:To investigate the application value of multimodal image three-dimensional reconstruction combined with facial nerve tracking in acoustic neuroma surgery.Methods:Forty-five patients with single acoustic neuroma accepted primary surgical treatment at Department of Neurosurgery, Yibin Hospital, West China Hospital, Sichuan University from November 2018 to June 2022 were chosen. The head, skull, brain tissues, arteriovenous system, tumor and facial nerves were reconstructed preoperatively by multimodal three-dimensional image reconstruction combined with facial nerve tracking. Preoperative planning was carried out according to the relationship between tumor and surrounding structures. The accuracy of facial nerve tracking was evaluated by intraoperative microscopic observation and nerve electrophysiological monitoring. House-Brackmann (H-B) criteria was used to evaluate facial nerve functions 2 weeks after surgery. Three months after surgery, all patients underwent enhanced MRI scanning, and combined with intraoperative findings, the degrees of acoustic neuroma resection were determined.Results:The facial nerves and their relations with acoustic neuroma were successfully tracked in all 45 patients; as confirmed by intraoperative microscopy and nerve electrophysiological monitoring, the results of facial nerves and their relations with acoustic neuroma were consistent in 42 patients and inconsistent in 3 patients. Using intraoperative nerve electrophysiological monitoring as gold standard, the accuracy of multimodal image three-dimensional reconstruction of the facial nerves was 93.3%. Preoperative facial nerve tracking results were highly consistent with intraoperative nerve electrophysiological monitoring results (Kappa=0.903, P<0.001). The facial nerves were intraoperatively preserved in 91.1% patients (41/45), and the facial nerve function was good in 86.7% patients (39/45) at 2 weeks after surgery. The total/subtotal resection rate of acoustic neuroma was 88.9% (40/45). No death, cerebrospinal fluid leakage, hematoma, or cerebral infarction were noted during the perioperative period. Conclusion:Multimodal image three-dimensional reconstruction combined with facial nerve tracking can help to protect blood vessels and nerves, improve total resection rate and facial nerve function retention rate in surgery of acoustic neuroma.

Objective:To evaluate the application of urological multimedia simulation technology (MST) based teaching method (UMST).Methods:From May 18, 2020 to August 31, 2021, 202 internship trainees in urology department of West China Hospital of Sichuan University were included. The interns were randomly divided into experimental group and control group with one hundred and one in each. UMST training was used in experimental group and classic training was used in control group. The score of clinical performance, direct observation of procedural skills (DOPS), satisfaction questionnaire score and the correlation between operation score of mould operation and DOPS score in experimental group were compared and analyzed. T-test were used for measurement data.Results:The scores of written examinations [(17.29±1.01) vs. (16.57±1.30)], DOPS scores [(7.14±0.36 ) vs. (6.76±0.33)] and internship satisfaction scores [(26.11±2.49) vs. (25.34±2.00)] from experimental group were all significantly higher than those from the control group(all P<0.05). Conclusions:Urological multimedia simulation technology based teaching method can improve the clinical skills of interns, promote their mastery of clinical knowledge and maximize their learning outcomes as well as satisfaction with internship training.

目的 探究手机普视3D SLAM AR软件在颅内幕上浅表肿瘤术前定位的价值.方法 分析10例颅内幕上浅表肿瘤患者的临床资料,病变直径2.3～6.8cm.术前利用MRI或CT扫描数据对肿瘤、头部轮廓、鼻部及双侧耳廓进行三维重建,载入普视3D SLAM软件,进行肿瘤术前定位(实验组),同时利用传统定位方法进行徒手定位(对照组),最后利用神经导航定位病变中心点作为评价标准,普视3D SLAM软件与徒手定位的中心点与导航定位的中心点之间的距离为定位误差,对结果进行统计学分析.结果 普视3DSLAM软件的定位误差[(0.48±0.04)cm]小于徒手定位法[(2.08±0.23)cm](P＜0.05).结论 普视3D手机AR软件Slam模块对颅内幕上浅表肿瘤定位较传统徒手定位法更准确,此外还能直观显示病变周围的皮层静脉、纤维束等结构,有助于合理地制定术前计划,最大程度地减小手术创伤.

目的:研究腹腔镜虚拟模拟培训系统在腹腔镜手术缝合技能训练中的应用.方法:回顾性分析2015年7月至2019年1月96例腹腔镜学员培训资料,根据培训方法,将48例直接进行腹腔镜手术缝合技能训练的学员作为对照组;48例使用腹腔镜虚拟模拟培训系统进行高级缝合技能培养后,再进行腹腔镜手术缝合技能训练的学员作为研究组.比较2组操作时间、吻合质量、缝合熟练程度、考核结果、操作失误.结果:对照组的操作时间明显高于研究组(P<0.01).对照组吻合质量总分和缝合熟练程度总分明显低于研究组(P<0.01),研究组考核结果明显优于对照组(P<0.01).对照组操作失误率高于研究组(P<0.05).结论:腹腔镜虚拟模拟培训系统可显著提高腹腔镜学员腹腔镜手术缝合技能,减少操作失误率.

目的 探讨颞叶低级别胶质瘤相关癫痫不同手术方式的临床疗效.方法 回顾性分析89例颞叶低级别胶质瘤所致癫痫病例资料,根据手术方式分为标准前颞叶联合海马、杏仁核切除组(扩大组,n=47)和标准前颞叶切除组(标准组,n=42).比较两组术后并发症、术后12个月Engel分级及ADL评分差异.结果 两组间术后并发症差异,无统计学意义(P>0.05).术后Engel分级与ADL评分,扩大组比标准组更佳(均P<0.05).结论 与单纯标准前颞叶切除比较,颞叶低级别胶质瘤相关癫痫采用标准前颞叶联合海马、杏仁核切除,能更有效控制癫痫,不会增加并发症,生活质量更高.

目的 探讨颅脑肿瘤患者术中快速静脉滴注甘露醇后间断开放腰大池引流管释放脑脊液降低颅压对颅脑肿瘤手术的影响和术后并发症的临床意义.方法 前瞻性选取我院2018年10月至2020年10月收治的颅脑肿瘤患者266例,随机分为观察组和对照组.观察组在全麻后腰椎穿刺蛛网膜下腔置管,置管前20 min快速静脉滴注甘露醇,打开颅骨后通过腰大池释放脑脊液降低颅压;对照组采用传统方式开颅手术.分析两组术中及术后情况.结果 观察组手术时间(300±105)min、术后住院天数(16.7±6.0)d短于对照组手术时间(352±95)min、术后住院天数(19.4±12.1)d,观察组肺部感染(13.64％)、术后皮下积液(9.10％)、颅内感染发生率(7.57％)低于对照组肺部感染(2.24％)、术后皮下积液(1.5％)、颅内感染发生率(0.74％),差异有统计学意义(P<0.05).结论 通过腰椎穿刺蛛网膜下腔间断引流联合静脉滴注甘露醇,可明显缩短手术时间,减少术后皮下积液、肺部感染发生率及颅内感染发生率,减少术后住院天数,且简单安全易行,值得临床推广.

目的 评价智能手机增强现实(augmented reality,AR)软件在颅内幕上占位性病变定位中的准确性.方法 回顾性分析15例颅内幕上占位性病变病人的临床资料,病变直径2.0～8.8 cm.术前在病变附近黏贴体表标志物后行MRI或CT扫描,利用扫描数据对病变和标志物进行三维重建,并将其传入手机AR软件进行病变体表定位.以导航定位病变中心点为参考,手机AR软件定位的中心点与导航定位结果的距离为定位误差,对结果进行统计学分析.结果 手机AR定位误差为(5 ± 3)mm,与导航定位比较,差异具有统计学意义(t=－2.671,P=0.018).Pearson相关分析显示:手机AR定位误差与病变大小密切相关(r=0.927,P＜0.05).本组以导航设计的切口均能覆盖AR定位病变的体表投影.结论 手机AR软件对颅内幕上直径2 cm以上的病灶定位可靠、使用方便,值得在临床中推广应用.

Objective To analyze and explore the influencing factors of the training quality of microsurgical anastomosis, to explore the effective scheme to improve the training quality,and so as to provide the basis for the improvement of microsurgical vascular anastomosis training.Methods 64 clinicians were selected from clinical skills center of West China Hospital to attend to the microsurgical vascular anastomosis training.Before the training,a self-designed questionnaire was used to investigate the age, sex,educational background,professional title of the participants and whether they had participated in the microsurgery before. The trainees were trained according to the course arrangement and their training times were recorded.At the end of the course, their end -to-end anastomosis of the abdominal aorta in mice was assessed by the same teacher.We compared the passing rate of assessment in groups with different ages,educational backgrounds,titles and microsurgical experiences.Results The number of training had an effect on the examination pass rate and the pass rate in groups with more training times was higher than it of group with less training times(P<0.05).Educational background,professional title and participation in microsurgery had little effect on the passing rate of the examination(P>0.05).Conclusion There is no need to limit the trainees'age,educational background, title and other factors in the microsurgical vascular anastomosis training.If possible,training times could be increased to help the trainees master the technique better.