脑内血肿穿刺引流简易定位法——“两点两线法”  

＂Two Points and Two Lines＂： a simple positioning method for puncture of intracranial hematoma

作　　者：魏大年[1] 刘铁坚[1] 张冠华[1] 朱永晖[1] 宋振华[1] 夏海军[1] 熊浩[2] 史保华[2] 刘承勇[1] 

机构地区：[1]南方医科大学第三附属医院神经外科,广州510630 [2]广东药学院附属第三医院神经外科,广州510410

出　　处：《中华神经医学杂志》2017年第1期70-74,共5页Chinese Journal of Neuromedicine

基　　金：广东省科技计划项目（2011B031800362）

摘　　要：目的介绍一种简单实用的颅内血肿穿刺精确定位的方法。方法南方医科大学第三附属医院神经外科自2014年8月至2015年8月采用钻孔血肿穿刺引流治疗脑出血患者16例。术前利用常规CT影像，根据空间立体定向原理，以基线平面的正中矢状线与双侧外耳孔联线的交点为坐标系参考原点，测量穿刺靶点相对原点的三维坐标值。根据测量结果在头皮上标记出靶点在头皮上的2个投影点，穿刺点指向两点的方向形成两条定位引导线，在两点两线的引导下进行血肿穿刺。结果本组患者完成手术时间20～50min，其中术前CT测量及头皮标记时间10～20min，手术操作时间10～30min；术后CT显示16例患者中引流管位置优良12例，中等4例；术中抽出血肿量10～30mL。术后配合尿激酶治疗3-5d，血肿完全消失5例，残留3～5mL7例，残留5～10mL4例；术后3个月患者日常生活功能评定（hOL）分级Ⅰ～Ⅲ级14例，Ⅳ级2例。结论“两点两线”法是一种简单实用、定位准确的手术定位方法，有助于提高脑出血穿刺的准确性和缩短手术时间，适合在临床推广使用。Objective To introduce a simple and practical method for precisely positioning for puncture of intracranial hematoma. Methods Sixteen patients with cerebral hemorrhage, admitted to our hospital from August 2014 to August 2015 and performed puncture drainage, were chosen in our study. Conventional CT was performed; based on the stereotactic principles, the intersection point between mid-sagittal line and combined line of bilateral external auditory foramen on baseline plane of CT imaging was used as origin of our coordinate system; the coordinate values, namely the 3D distances between the target spot and the origin, were used to mark two projection points on the scalp. The lines between designed point of puncture on scalp and the two projection points were used as guiding lines, by which, hematoma puncture could be precisely performed. Results This method was taken into practice for these 16 patients with cerebral hemorrhage with operation time within 20-50 minutes, including preoperative measurement and scalp marking for 10-20 minutes and operation for 10-30 minutes. The locations of the drainage tubes were precisely verified by CT： 12 of which were excellent, and 4 were moderate. Volume of removed hematoma during the operation was 10-30 mL. After 3-5 days of postoperative treatment with urokinase, satisfactory results were achieved： hcmatoma complete obliteration was noted in 5 patients, residual volume 3-5 mL in 7 patients and residual volume 5-7 mL in 4 patients. Conclusion ＂Two points and Two lines＂ is a simple, practical, accurate-positioning and time-consuming method for operation of cerebral hemorrhage, which is quite suitable for clinical application.

关 键 词：高血压脑出血 微创 穿刺 两点两线定位法 

分 类 号：R651.15[医药卫生—外科学]