慢性扩张性脑内血肿的诊断与治疗（附37例报告）  

Diagnosis and treatment of chronic expanding intracerebral hematoma： report on 37 cases

作　　者：魏麟[1] 李猛[1] 张健[2] 金澎[3] 曲春城[4] 王鹏[1] 刘玉光[5] 张庆林[1] 孙金龙[1] 

机构地区：[1]山东省千佛山医院神经外科,济南250014 [2]山东省临沂市人民医院神经外科 [3]青岛大学脑科医院神经外科 [4]山东大学第二医院神经外科 [5]山东大学齐鲁医院神经外科

出　　处：《中华神经外科杂志》2010年第6期513-516,共4页Chinese Journal of Neurosurgery

基　　金：基金项目：山东大学“985”工程二期神经外科建设项目（10000065950010）

摘　　要：目的 通过对慢性扩张性脑内血肿（CEICH）病例的总结,提高对本病的诊断及治疗水平.方法 将本组37例CEICH患者的临床资料,结合相关文献复习进行总结分析,提出诊断此病的主要依据和有效治疗方法 .结果 本病可发生于脑内任何部位,多为单发,多发少见;本组术前24例误诊（65%）,37例均经手术治疗,13例术后病理报告为血管畸形,随访结果 29例正常工作生活,7例有不同程度的神经功能障碍,1例死于对侧半球脑出血.结论 诊断CEICH的主要依据：（1）缓慢进展的颅内压增高症状和（或）临床体征;（2）影像学提示脑实质内混杂密度、低密度、高密度或等密度的囊性或液性占位病变;（3）有环状圆形或类圆形不规则强化.具备上述中的两点即应考虑CEICH的可能,三点都具备可诊断CEICH.手术清除血肿和切除包膜是有效治疗方法 .Objective To improve the diagnosis and treatment level of chronic expanding intracerebral hematoma （CEICH）. Methods The clinical data of 37 cases with CEICH were analyzed retrospectively with literature review, we wanted to find the evidence for diagnosis and the effective method for treatment. Results CEICH could involved in anywhere of brain, most of them were solitary, seldom seen multiple. 24 cases were misdiagnosed as CEICH before operation （65%）. All the 37 cases were operatived, and small vascular malformation was detected in 13 cases in pathological examination. All cases were followed - up after operation, 29 patients recovered quite well, 7 patients suffered focal neurological deficit, 1 patient died of rebleeding of contralateral cerebral hemisphere. Conclusion We supposed the three points can be the evidence of diagnosis. （1） Developed slowly of the clinical presentation of increased intracranial pressure. （2） The radiological characteristics can include mass effect of encapsulated or liquefied lesion with unisodensity, low density, high density or isodensity （CT value 20 ～ 70 Hu）. （3） Irregular ringed round or similar to round enhancement. We should think about CEICH if included two above points,and we should make a definite diagnosis of CEICH if three points were included. Surgery to evacuate the hematoma and remove the capsule should be the effective method to CEICH.

关 键 词：脑内血肿 血管畸形 诊断 外科手术 

分 类 号：R651.1[医药卫生—外科学]