基底核区高血压脑出血的立体定向治疗  

Stereotactic treatment of hypertensive intracerebral hemorrhage in basal ganglia region

作　　者：黑博 王佳 王伟 赵全军 Hei Bo;Wang Jia;Wang Wei;Zhao Quanjun(Stereotactic and Neurofunctional Center of the 306^th Hospital of PLA,Beijing 100101,China)

机构地区：[1]解放军第三○六医院立体定向及脑功能性疾病诊治中心,北京100101

出　　处：《中华神经外科杂志》2019年第1期63-66,共4页Chinese Journal of Neurosurgery

基　　金：首都临床特色应用研究项目(Z1611000002516199).

摘　　要：目的评价立体定向穿刺置管引流治疗基底核区高血压脑出血的疗效。方法回顾性分析2015年8月至2018年3月解放军第三〇六医院立体定向及脑功能性疾病诊治中心收治的65例基底核区高血压脑出血患者的临床资料。其中35例行硬通道穿刺引流术(硬通道组),30例行机器人辅助立体定向穿刺置管引流术(立体定向组)。对两组患者的年龄,性别,合并症,出血时间,术前血肿量,术前格拉斯哥昏迷评分(GCS),术前、出院前、术后3个月的Barthel评分,术后血肿引流时间进行比较分析。结果(1)立体定向组的术后血肿彻底引流时间明显少于硬通道组,两组的差异有统计学意义(Z=3.69,P<0.01)。(2)立体定向组出院前[(89.7±7.2)分]及术后3个月[(94.0±5.7)分]的Barthel评分均显著高于硬通道组[出院前:(75.3±7.2)分,术后3个月:(76.4±8.2)分,均P<0.01],且立体定向组的评分改善较硬通道组更为明显。结论应用立体定向穿刺置管引流术治疗基底核区高血压脑出血患者,其术后血肿引流时间短,可迅速解除血肿对脑组织的压迫,促进患者神经功能的康复。Objective To evaluate the efficacy of stereotactic hematoma evacuation surgery for hypertensive cerebral hemorrhage in basal ganglia region. Methods A retrospective analysis was performed on 65 cases of hypertensive cerebral hemorrhage in the basal ganglia from August 2015 to March 2018 at the Stereotactic and Neurofunctional Center of the 306th Hospital of PLA. According to different surgical methods, those patients were divided into 2 groups. In the hematoma puncture group, 35 patients underwent hematoma puncture and drainage surgery;in the stereotaxis group, 30 patients underwent stereotactic puncture and catheter drainage surgery assisted by robot Remebot. The baseline conditions, bleeding time, volume of hematoma, preoperative GCS (Glasgow coma scale) score, Barthel score before discharge and at 3 months post operation, and the time of thorough hematoma drainage were compared between the 2 groups. Results (1) The time for thorough hematoma drainage in the stereotaxis group was significantly less than that in the hematoma puncture group. There was a significant difference between the 2 groups (Z=3.69, P<0.01). (2) Barthel scores before discharge (89.7±7.2) and at 3 months post operation (94.0±5.7) in stereotaxis group were significantly higher than those in hematoma puncture group (before discharge: 75.3±7.2, 3 months post operation: 76.4±8.2, both P<0.01). Conclusion Stereotactic hematoma evacuation surgery could significantly accelerate the removal time of hematoma in patients with hypertensive intracerebral hemorrhage, quickly relieve the compression of brain tissue by hematoma and promote the recovery of neurological function.

关 键 词：颅内出血 高血压性 基底神经节 神经外科手术 立体定向 治疗结果 

分 类 号：R651.1[医药卫生—外科学]