原发性高血压脑干出血的微创手术治疗  

Minimal invasive surgical treatment of primary hypertensive brainstem hemorrhage

作　　者：陈立华[1] 魏群[1] 徐如祥[1] 李运军[1] 李文德[1] 赵浩[1] 高进宝[1] 于斌[1] 张洪钿[1] 

机构地区：[1]北京军区总医院附属八一脑科医院,北京100700

出　　处：《临床神经外科杂志》2015年第5期349-353,共5页Journal of Clinical Neurosurgery

摘　　要：目的探讨原发性高血压脑干出血微创手术治疗的方法与手术技巧。方法回顾性分析经微创手术治疗的32例原发性高血压脑干出血患者的临床资料,总结分析手术指征和手术入路选择、手术技巧、治疗效果及随访资料。其中中脑出血3例,脑桥出血22例,延髓血肿1例,中脑-脑桥联合出血4例,脑桥-延髓出血2例。血肿量3.6-21 ml,平均8.6 ml。按出血量将脑干出血分为3组：≤5 ml,5.1-10 ml,〉10 ml。术中采用神经电生理监测17例,神经导航引导手术25例。3个月后按照格拉斯哥预后量表（GOS）评定治疗效果。结果 32例患者均经微创手术成功清除血肿,其中27例血肿清除彻底,另外5例大部分清除血肿,1个月内无手术相关死亡。术后并发肺部感染23例,出现上消化道出血11例。术后3个月存活28例,死亡4例。术后随访3个月,GOS评分5分3例、4分9例、3分12例、2分4例、1分4例。结论采用微创显微神经外科技术,可明显改善原发性高血压脑干出血患者的疗效。选择正确的手术入路和熟练的显微外科技巧可提高脑干出血手术治疗的成功率。Objective To explore the operation method and technique of minimal microsurgical treatment for primary hypertensive brainstem hemorrhage. Methods The clinical data of 32 patients with primary hypertensive brainstem hemorrhage were analyzed retrospectively. All patients were operated on through microsurgery. The surgical indication and approach,operation technique,therapeutic efficacy and follow-up data were reviewed. Volume of bleeding in the patients were ranged from 3. 6 to 21 ml,including mesencephalon haematoma in 3 cases,pons haematoma in 22 cases,medulla oblongata haematoma 1 cases,mesencephalon and the pons bleed in 4 cases,medulla oblongata and pons haematoma 2 cases. The haematoma volume were 3. 6-21ml（ mean 8. 6 ml）.They were divided into three groups according to the haematoma volume ≤ 5 ml,5. 1-10 ml,10〉ml. Neurophysiological monitoring was performed in 17 cases,25 cases of neuronavigation operation. After three months,treatment outcome were assessed according to the Glasgow outcome scale（ GOS）. Results All cases were successfully removed hematoma through minimal microsurgical technique under neuronavigation and electrophysiologic monitoring without death1 months duration after operation. The hemotomas were total successfully removed in 27 cases,subtotal resection in 5. Postoperatively,28 cases were survival and 4 died. Intraoperative electrophysiological monitoring had been used in 17 cases and neuronavigation in 13. According to GOS,the following up of three months showed 3 patients were recovered well,9 moderate disabled,12 severely disabled,4 vegetatively survived and 4 died. Conclusions The minimal microsurgical technique can significantly improve outcomes in patients with primary hypertension brainstem hemorrhage. The optimal operation approach and exquisite microsurgical technique could raise the successful rate of the hematomas resection.

关 键 词：原发性高血压 脑干出血 手术入路 显微技巧 

分 类 号：R651.1[医药卫生—外科学]