徒手定向技术在高血压脑出血穿刺引流中的应用  

Application of quick percutaneous puncture drainage technique according to CT scanning to treat hypertensive intracerebral hemorrhage

作　　者：孙峻峰[1] 熊东胜 高强[1] 魏毅君[2] 邵威[2] 王晓峰[2] 王茂德[3] 

机构地区：[1]陕西省宝鸡市人民医院神经外科,721000 [2]解放军第三医院神经外科 [3]西安交通大学第一附属医院神经外科,710048

出　　处：《疑难病杂志》2016年第4期355-357,361,共4页Chinese Journal of Difficult and Complicated Cases

基　　金：国家"十二五"科技支撑计划项目(2011BAI08B05)

摘　　要：目的观察徒手定向技术用于高血压脑出血微创穿刺引流的临床疗效。方法回顾性分析2010年6月—2015年6月宝鸡市人民医院神经外科和解放军第三医院神经外科应用徒手定向技术经颅骨钻孔或经皮锥颅后硅胶软管穿刺引流治疗高血压脑出血148例患者临床资料。依据CT片设计体表穿刺点、靶点及穿刺路径,校正听眦线(OM线)并计算确定穿刺轴位面,测量穿刺点距前中线体表弧线距离确定穿刺冠状面,测量穿刺方向对侧体表点距前中线体表弧线距离设置对侧标志点引导矢状面穿刺角度。结果 148例共选择192个靶点,到达血肿腔预定靶点142个(74.0%),在血肿腔内但偏离预定靶点28个(14.6%),在血肿周边但能满足引流要求19个(9.9%),偏离血肿需要重新穿刺调整引流管3个(1.6%),穿刺有效率98.4%。结论徒手定向技术不需要安装框架或特殊仪器,仅依据CT图像,数分钟内设计好脑内血肿的穿刺点、穿刺方向及深度,是一种简便准确、安全有效的穿刺定向技术,临床治疗应用效果良好。Objective To observe the clinical effect of minimally invasive puncture and drainage of hypertensive cerebral hemorrhage by manual technique.Methods From June 2010 to June 2015,hypertensive intracerebral hemorrhage clinical data of 148 patients in department of neurosurgery,Baoji City Peoples Hospital and Liberation Army third Hospital were retrospectively analyzed,these patients received unarmed directional technology by drilling skull or after skull skin silicone tube puncture drainage.According to the CT to design body puncture point,target and path of puncture,correct the angular line（OM） and to calculate and determine puncture axial surface,measuring puncture dot from the midline of the body surface arc determined puncture on the coronal plane,measure the puncture direction to the side surface before the dot pitch distance from the midline of the body surface curve design structure of side marker to guide sagittal puncture angle.Results Total of148 cases and 192 target points,and reached the hematoma cavity predetermined target in 142（74.0%）,hematoma cavity but deviates from a predetermined target in 28（14.6%）,in the surrounding hematoma but can meet the drainage requirements in 19（9.9%）,hematoma deviation need to re adjust the puncture drainage tube in 3（1.6%） and puncture rate was98.4%.Conclusion Unarmed directional technology do not need to install the frame or special instrument,only based on CT image,design good intracerebral hematoma puncture point within a few minutes,direction and depth of the puncture is a simple,accurate,safe and effective directional puncture technique and the clinical treatment effect of good.

关 键 词：高血压脑出血 徒手定向技术 穿刺术 

分 类 号：R651.1[医药卫生—外科学]