神经内镜下脑出血血肿清除术止血技术的探讨  

Exploration of neuroendoscopic hemostatic techniques for intracerebral hematoma removal

作　　者：黄进能[1] 范学政[1] 朱寿鸿[1] 胡栓贵[1] Huang Jinneng Fan Xuezheng Zhu Shouhong Hu Shuangui(Department of Neurosurgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi 530011, China)

机构地区：[1]广西中医药大学附属瑞康医院神经外科,南宁530011

出　　处：《中国微侵袭神经外科杂志》2016年第11期481-483,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家"十二五"科技支撑计划课题(编号:2011BAI08B05);广西壮族自治区中医药科技专项基金(编号:GZPT13-19)

摘　　要：目的探讨神经内镜脑出血血肿清除的效果以及相关止血技术。方法回顾性分析42例应用神经内镜进行血肿清除治疗的脑出血病例资料。总结术前、术中预防出血的措施,以及内镜下应用"内镜结合吸引器"直视下止血方法。结果 42例病人手术平均出血量(109.5±32.4)ml,手术时间(70.0±12.4)min,切口长度(5.1±0.8)cm及骨窗面积(7.1±0.5)cm^2。术后24 h内复查CT,血肿清除完全38例,血肿少量残留4例,无术后再出血发生。术后1例因脑疝未缓解死于脑干功能衰竭,1例死于肺部感染。存活40例病人均随访6个月以上,格拉斯哥预后评分(GOS)5分16例,4分14例,3分5例,2分5例。结论术前及术中实施预防出血的措施有助于减少术中出血,内镜下"内镜结合吸引器"直视下止血,方法简便、有效,值得推广普及。Objective To explore and clinical effect of evacuating intracerebral hematomas using neuroendoscopy and related hemostatic technologies with neuroendoscope. Methods The clinical data of 42 patients with intracerebral hematoma removal by neuroendoscopy were analyzed retrospectively. The preoperative and intraoperative measures for preventing bleeding, and some methods for hemostasis under direct vision with aspirator combined with endoscope in intracerebral hematoma removal, were summarized. Results In 42 patients, the mean blood loss was 109.5±32.4 ml, the mean operation time 70.0±12.4 min, the mean incision length 5.1±0.8 cm and the mean bone window size 7.1±0.5 cm^2. Postoperative CT scan within 24 hours confirmed that the hematomas were evacuated totally in 38 patients and there was a small amount of residual in 4. No postoperative bleeding occurred. Two patients died of brainstem function failure and pulmonary infection respectively. Forty survived patients were followed up for more than 6 months. Glasgow Outcome Scale（GOS） score was 5 points in 16 patients, 4 in 14, 3 in 5 and 2 in 5. Conclusions The preoperative and intraoperative prophylaxis is helpful to reduce intraoperative hemorrhage and the method for hemostasis using aspirator combined with endoscope is simple and practical, thus being worth of popularization in clinical application.

关 键 词：颅内出血 神经内镜 血肿清除术 止血技术 

分 类 号：R651.1[医药卫生—外科学]