CT引导立体定向神经内窥镜手术治疗高血压脑出血  

CT-guided stereotactic and neuroendoscope-assisted surgery for hypertensive cerebral hemorrhage

作　　者：翁超群 周金东 金清东 林璜 

机构地区：[1]福建省蒲田市第一医院神经外科,351100

出　　处：《中华神经医学杂志》2008年第4期414-416,共3页Chinese Journal of Neuromedicine

摘　　要：目的探讨CT引导立体定向神经内窥镜手术治疗高血压脑出血的方法和疗效。方法选择我科自2005年至2006年收治的25例高血压脑出血患者，局麻下安装ASA602A型定向仪，CT扫描后导入手术计划系统，选择血肿最大层面，取血肿中心偏后1～1．5cm处为靶点，测得坐标，设计手术切口及入路，全麻下环钻开颅，颅骨孔直径约3cm，导入血肿排空针，排出部分血肿后．置入神经内窥镜进行血肿清除并止血。结果25例高血压脑出血患者中术后24h血肿清除率达60％-70％10例：80％-90％11例；达90％以上4例，给予拔除引流管。72h复查颅脑CT，患者血肿清除率均达90％以上，均拔除引流管。术后3个月日常生活能力评分示显著好转14例；好转9例：死亡2例，分别于术后10d、14d死于肺部感染。结论立体定向神经内窥镜手术治疗高血压脑出血是一种定位精确、微创、血肿清除率较高和疗效较好的治疗方法。Objective To evaluate the curative effect of CT-guided stereotactic and neuroendoscope-assisted operation on cerebral hemorrhage caused by hypertension. Methods Twenty-five cases of cerebral hemorrhage caused by hypertension treated in our department in 2005-2006 were selected. ASA602A type position finder was installed under local anesthesia, and operation planning system was imported alter CT scanning. The target point was selected at 1-1.5 cm posterior the central point of the largest hematoma, then the coordinate of the target point was calculated, and incisal opening and operation approach were programmed. Brain operation with trephine was performed under general anesthesia. Alter hematoma evacuating cannula were placed in the skull hole of 3 cm in diameter to remove partial hematoma, neuroendoscope was inserted to get rid of hematoma and stop bleeding. Results Of 25 patients with cerebral hemorrhage, 24 h alter operation, 10 received evacuation of 60% -70% ofhematomas, 11 did 80%-90%, 4 did more than 90%; 72 h alter operation, all patients received evacuation of more than 90%. During the follow-up for 3 months alter the operation, activities of daily living （ADL） scoring showed excellent improvement in 14 cases and amelioration in 9; 2 patients died from lung infection 10, 14 d alter operation, respectively. Conclusions CT-guided stereotactic and neuroendoscope-assisted surgery is a safe, effective and minimally invasive method to treat hypertensive cerebral hemorrhage.

关 键 词：颅内出血 高血压性 立体定位技术 神经内窥镜检查 

分 类 号：R651.1[医药卫生—外科学]