基于白质纤维束保护的幕上高血压性脑出血手术治疗专家共识(2024版)  

Chinese expert consensus on surgical treatment of hypertensive intracerebral hemorrhage based on parafascicular approach(2024 edition)

作　　者：中国医师协会神经外科医师分会 中华医学会神经外科学分会 中国卒中学会脑出血微创治疗分会 重庆市医学会卒中分会 冯华 胡荣 张超 赵大威 Chinese Congress of Neurological Surgeons of Chinese Medical Doctor Association;Neurosurgery Branch of the Chinese Medical Association;Intracerebral Hemorrhage Minimally Invasive Surgical Treatment Branch of the Chinese Stroke Association;Stroke Branch of the Chongqing Medical Association;Feng Hua;Hu Rong(不详;Institute of Neurosurgery of Chinese People′s Liberation Army,Army Medical University,Chongqing 400038,China;Department of Neurosurgery,the First Affiliated Hospital,Army Medical University,Chongqing 400038,China)

机构地区：[1]不详 [2]陆军军医大学全军神经外科研究所,重庆400038 [3]陆军军医大学第一附属医院神经外科,重庆400038

出　　处：《中华医学杂志》2024年第33期3096-3109,共14页National Medical Journal of China

基　　金：重庆市科卫联合医学科研攻关项目(2023GGXM003);重庆市科卫联合医学科研重点项目(2023ZDXM030)

摘　　要：高血压性脑出血是国人致死和致残的主要原因之一。手术治疗可降低脑出血患者的病死率但不能改善功能预后,促进存活患者的功能恢复是高血压性脑出血的救治核心。皮质脊髓束是维持运动功能的主要下行白质纤维束,其完整性决定运动功能恢复程度。因此,减轻皮质脊髓束损伤有望改善幕上深部脑出血患者的运动功能障碍。规范白质纤维束旁入路的微创手术治疗的适应证、手术策略以及操作规范等细节,实现最大限度地血肿清除和最小程度的纤维束干扰,有利于促进白质纤维束的恢复,改善神经功能预后。中国医师协会神经外科医师分会、中华医学会神经外科学分会、中国卒中学会脑出血微创治疗分会和重庆市医学会卒中分会共同组织国内相关的专家,通过系统查询和评价现有相关的研究证据,参考国际相关共识和指南内容,结合国情和国内需求,针对基于白质纤维束保护的高血压性脑出血手术治疗的术前检查、手术指征、术中定位、手术方式、止血技术和围手术期管理等方面共形成31条推荐意见,希望为脑出血的手术治疗提供重要参考。Hypertensive intracerebral hemorrhage(HICH)is one of the main causes of death and disability in Chinese people.Surgical treatment can reduce the mortality rate of patients with HICH,but cannot improve functional prognosis.Therefore,promoting the neurological function recovery of surviving patients has become the focus of treatment for HICH.The corticospinal tract(CST)is the main descending fiber bundle that maintains motor function,and its integrity determines the degree of motor function recovery.Therefore,reducing CST injury is expected to improve motor dysfunction in patients with supratentorial deep HICH.Standardizing the indications,surgical strategies,and operational procedures for minimally invasive surgical treatment via the parafascicular approach can achieve maximum hematoma clearance and minimal white fiber bundle damage,which is beneficial for promoting the recovery of white matter fibers and improving neurological function prognosis.The Chinese Congress of Neurological Surgeons of Chinese Medical Doctor Association,the Neurosurgery Branch of the Chinese Medical Association,the Intracerebral Hemorrhage Minimally Invasive Surgical Treatment Branch of the Chinese Stroke Association,and the Stroke Branch of the Chongqing Medical Association organized relevant domestic experts to systematically query and evaluate existing relevant research evidence,refer to relevant international consensus and guidelines,and combine national conditions and domestic needs.A total of 31 recommendations were formed for preoperative examination,surgical indications,intraoperative positioning,surgical methods,hemostasis techniques,and perioperative management for surgical treatment of HICH based on white matter fiber protection,hoping to provide important reference for the surgical treatment of HICH.

关 键 词：脑出血 高血压性脑出血 皮质脊髓束 白质纤维束旁入路 微创治疗 共识 

分 类 号：R544.1[医药卫生—心血管疾病] R651.1[医药卫生—内科学]