摘要目的:应用3D slicer+Sina软件行颅内血肿三维重建后定位，探讨局部麻醉(局麻)微创血肿穿刺引流术治疗高龄脑出血患者的效果。方法:收集74例首次发病的有手术指针且生命体征平稳的老年(≥75岁)脑出血患者，分别利用3D slicer结合Sina软件定位血肿(软件定位组40例)或CT定位血肿(CT定位组34例)后行局麻血肿穿刺引流术。对术前准备时间，血肿定位，血肿穿刺满意度，血肿清除率，手术时间，术后再出血及格拉斯哥昏迷(GCS)评分进行相关统计学分析。结果:两组术前准备时间软件定位组优于CT定位组[(5.5±3.4)min和(8.5±2.7)min， t＝3.337， P＝0.001]；软件定位组血肿穿刺满意度(90.0%和70.6%， χ2＝4.51， P＝0.034)及血肿清除率[(87.5±3.4)%和(80.3±2.7)%， t＝10.10， P＝0.000]高于CT定位组( P<0.05)；两组手术时间，血肿定位，再出血率及GCS评分比较差异均无统计学(均 P>0.05)。 结论:3D slicer+Sina软件可精确定位血肿，生命体征平稳的高龄脑出血患者，局麻微创血肿穿刺引流术安全有效。

abstractsObjective:To explore the effect of minimally invasive hematoma puncture and drainage in the treatment of elderly patients with cerebral hemorrhage by using 3D slicer and Sina software to conduct 3D reconstruction and preoperative localization of intracerebral hematoma.Methods:A total of 74 elderly patients with a first-onset intracerebral hematoma aged ≥75 years, having surgical indications and stable vital signs were grouped into 3D slicer plus Sina software localization group(as group A, n=40)or CT localization group(as group B, n=34). Based on the localization, hematoma puncture and drainage were performed after local anesthesia.Preoperative preparation time, hematoma location, puncture success rate, postoperative hematoma clearance rate, postoperative re-bleeding rate and GCS score were statistically analyzed.Glasgow coma scale(GCS)scores were used in predicting the mortality.Results:The preoperative preparation time was significantly shorter in group A than in group B[(5.5±3.4)min vs.(8.5±2.7)min, t=3.337, P=0.001]. The success rate of hematoma puncture and drainage(90.0% and 70.6%, χ2=4.51, P=0.034)and postoperative hematoma clearance rate[(87.5±3.4)% and(80.3±2.7)%, t=10.10, P=0.000]were higher in group A than in group B. There were no significant differences in operative time, the accuracy of hematoma localization, re-bleeding rate and GCS score between the two groups( P>0.05). Conclusions:3D slicer plus Sina software can precisely locate the intracerebral hematoma, and minimally invasive hematoma puncture and drainage of intracerebral hematoma under local anesthesia were safe and effective in the treatment of elderly patients with intracerebral hemorrhage.