影像引导锁孔入路内镜幕上脑内血肿清除:119例分析  

Image-guided endoscopic evacuation of supratentorial intracerebral hematoma by keyhole approach: an analysis of 119 patients

作　　者：徐永革[1] 王岩[1] 张国珍[1] 苏辉[1] 夏小雨[1] 宋昭[1] 

机构地区：[1]北京军区总医院附属八一脑科医院内镜神经外科,100700

出　　处：《中国微侵袭神经外科杂志》2015年第7期313-316,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨微创内镜下清除自发性幕上脑出血的效果及手术技巧。方法回顾性分析119例自发性幕上脑出血病人的临床资料,出血位于基底核区84例,丘脑区14例,脑叶14例,脑室7例。均接受全麻下影像引导锁孔入路内镜脑内血肿清除术。根据出血部位不同,分别采用不同部位锁孔入路。结果 119例病人皆安全耐受手术。发病至手术时间3.5～74 h,平均8 h。手术耗时45～115 min,平均61 min。血肿清除率-10.0%～100%,平均92.8%。残余血肿量0～58 ml,平均2 ml。10例病人再次手术,占8.4%。住院死亡5例,病死率4.2%。住院天数5～61 d,平均14 d。出院时GCS评分提高-2～6分,平均3.9分。结论影像引导内镜下清除幕上脑出血的方法,可彻底清除血肿,止血可靠,创伤较小,对脑的功能区域保护好,术后并发症少,其可作为20 ml以上未发生脑疝的自发性幕上脑出血的推荐方法之一。术前确认出血停止,术中升高血压状况下止血,术后严格控制血压是减少再出血的关键。Objective To explore the surgical outcome and techniques of minimally invasive endoscopic surgery for spontaneous supratentorial hemorrhage. Methods Clinical data of 119 patients with spontaneous supratentorial hemorrhage were analyzed retrospectively, including 84 patients with hemorrhage in the basal ganglia, 14 in the thalamic area, 14 in different brain lobes and 7 in the ventricles. All the patients underwent image-guided endoscopic evacuation of supratentorial intracerebral hematoma by keyhole approach under general anesthesia. The surgical keyhole approach was chosen according to the position of hemorrhage. Results All the patients tolerated surgery without major intra-surgical complication. The duration time from onset to surgery was 3.5 to 74 h with the median time of 8 h. The surgical duration lasted for 45 to 115 min with the median time of 61 min. The rate of hematoma evacuation was-10.0% to 100% with the median rate of 92.8%. The residual hematoma volume was 0 to 58 ml with the median volume of 2 ml. Ten patients（8.4%） received surgery again. Five patients died and the clinical mortality rate was 4.2%. Duration of hospitalization was 5 to 61 d with the median time of 14 d. GCS scores at discharge was improved by-2 to 6 points with the median score of 3.9 points. Conclusions Image-guided endoscopic evacuation method for supratentorial hemorrhage can completely evacuate the hematoma, achieve reliable hemostasis and minimal trauma and protect the functional area well with low rate of post-operative complications. It can be a recommended method for supratentorial intracerebral hematoma with a volume more than 20 ml without cerebral hernia. The critical points for reducing rebleeding rate are that conformation of no bleeding before surgery, hemostasis maintain under increased blood pressure during surgery and strict control of blood pressure after surgery.

关 键 词：脑出血 神经内镜 神经导航 入路 锁孔 立体定位技术 

分 类 号：R651.1[医药卫生—外科学]