个体化开颅联合脑室灌洗引流治疗重型继发性脑室出血的临床研究  

Clinical analysis of severe secondary intraventricular hemorrhage via individualized craniotomy and ventricular drainage

作　　者：崔永华[1] 夏咏本[1] 李爱民[2] 颜士卫[2] 张立勇[1] 韩清[1] 陈恒林[1] 

机构地区：[1]南通大学附属建湖医院神经外科,江苏建湖224700 [2]徐州医学院附属连云港医院,江苏连云港222002

出　　处：《中国现代医学杂志》2013年第23期62-65,共4页China Journal of Modern Medicine

摘　　要：目的分析个体化开颅联合脑室灌洗引流在重型继发性脑室出血中的应用,并观察其临床效果。方法采用个体化开颅联合脑室灌洗引流治疗重型继发性脑室出血39例（A组）,其中微骨瓣经额叶皮质入路22例（含经额上沟入路2例）;微骨瓣经纵裂-胼胝前部入路7例;顶枕骨瓣经三角区入路5例;额颞（顶）骨瓣经颞中回入路5例。以传统的单纯脑室外引流术治疗该类患者80例为对照组（B组）,并相互比较。结果随访1~6个月,按GOS评分。A组恢复良好10例,中度残疾12例,重度残疾7例,植物生存4例,死亡6例。B组恢复良好8例,中度残疾14例,重度残疾19例,植物生存12例,死亡27例。A组患者预后明显优于B组,差异有统计学意义。结论个体化开颅联合脑室灌洗引流优于单纯脑室外引流,是治疗重型继发性脑室出血的有效手段,可有效清除血肿,减少并发症,改善患者预后。【Objective】 To observe the outcomes of severe secondary intraventricular hematoma via individualized craniotomy and ventricular drainage and explore the optimal individual-based therapy suitable for these patients.【Methods】 We ananlyzed the clinical data of group A and group B.Group A： 39 cases of severe intraventricular hemorrhage via individualized craniotomy and ventricular drainage were analyzed retrospectively.Including micro-flap via transfrontal cortex approach（2 patients via transfissure approach） in 22 patients,via anterior interhemispheric transcallosal approach in 7 patients,paroccipital lobe via triangular area approach in 5 patients,front otemporoparietal lobe（or fronto temporal lobe） via the middle temporal gyrus approach in 5 patients.Group B： 80 cases of severe intraventricular hemorrhage with simple ventricular drainage.【Results】 Follow-up was performed from 1 month to 6 months,according to GOS score.Group A： of all the 39 patients,10 recovered well,12 moderately disabled,7 severely disabled,4 vegetative survived,6 died.Group B： 8 recovered well,14 moderately disabled,19 severely disabled,12 vegetative survived,27 died.【Conclusions】 Individualized craniotomy and ventricular drainage produces better therapeutic effects than simple ventricular drainage in the treatment of severe secondary intraventricular hemorrhage,can effectively remove hematoma,reduce complications and improve quality of life.

关 键 词：重型继发性脑室出血 显微外科手术 个体化开颅 脑室外引流 

分 类 号：R651.15[医药卫生—外科学]