CT引导立体定向抽吸术治疗自发性基底节区出血临床研究  

CT guided stereotactic aspiration in the treatment of spontaneous hemorrhage in basal ganglia region:A clinical study

作　　者：廖洪民[1] 黄建军[1] 王勇[1] 胡健[1] 

机构地区：[1]贵州航天医院神经外科,遵义563003

出　　处：《中国实用神经疾病杂志》2017年第3期18-21,共4页Chinese Journal of Practical Nervous Diseases

基　　金：中国航天科工集团医疗卫生基金课题(2014-LCYL-011)

摘　　要：目的分析CT引导立体定向血肿抽吸术与内科保守治疗基底节区中等量出血的疗效。方法回顾性分析2014-01—2015-11我院收治的自发性基底节区出血(出血量20~50 mL)患者58例,分为立体定向手术组(32例)和内科治疗组(26例),采用美国国立卫生研究院卒中量表(NIHSS)评定2组治疗前及治疗后14、30d的神经功能缺损程度,并随访评估2组治疗后90d扩展格拉斯哥预后评分(GOS-E)。结果立体定向手术组血肿完全清除24例(75%),次全清除8例(25%)。手术组患者治疗后14dNIHSS评分低于内科组,但差异无统计学意义(P>0.05);手术组患者治疗后30dNIHSS评分低于内科组(P<0.05),且治疗后90dGOS-E评分高于内科组(P<0.05),2组发病后30d内病死率比较差异有统计学意义(P<0.05)。结论 CT引导立体定向抽吸术可较快清除幕上20~50mL的脑内血肿,手术安全有效且损伤小,远期疗效优于内科保守治疗。Objective To compare the efficacy of CT guided stereotactic aspiration and conservative treatment of moderatevolume spontaneous basal ganglia hemorrhage. Methods Fifty-eight patients with moderate-volume basal ganglia hemorrhage（20- 50mL） ,from January 2014 to November 2015 in our hospital, according to different treatment methods, were divided into two groups：stereotactic surgery group（n = 32） and conservative treatment group（n = 26）. Neurologic impairment degree scores were assessed using NIHSS before treatment and 14 and 30 days after treatment. The Extended Glasgow Outcome Scale（GOS-E） scores at 90 days after treatment were assessed for comparing the outcome between the two groups. Results In stereotacfic surgery group, hematoma completely removed in 24 cases（75 % ）, subtotal removal in 8 cases（25 % ）. The NIHSS scores in stereotactic surgery group at 14 days after treatment were lower than those in conservative treatment group,although the difference was not sta- tistically significant（P〉0.05）. The NIHSS scores in stereotactic surgery group at 30 days were significantly lower than those in conservative treatment group （P 〈 0.05）. The GOS-E scores in stereotactic surgery group 90 days after treatment were significantly higher than those in conservative treatment group （P 〈 0.05）. The mortality rate was different between the two groups within 30 days of ictus（P〈0.05）. Conclusion CT-guided stereotactic aspiration is effective and safe,and minimally invasive, and can quickly remove the intracerebral hematoma with volume between 20mL to 50mL. The longterm efficacy of stereotactic aspiration is better than that of conservative treatment.

关 键 词：立体定向抽吸术 保守治疗 脑出血 基底节区 

分 类 号：R743.34[医药卫生—神经病学与精神病学]