神经内镜治疗基底节区脑出血的技术及疗效研究  

Study on the efficacy and technical details of endoscopic surgery in basal ganglia hemorrhage

作　　者：李明 范学政 胡志卿 林超群 易剑波 邱波 LI Ming FANG Xuezheng HU Zhiqing LIN Chaoqun YI Jianho QIU Bo(Department of Neurosurgery, Shenzhen Guangming New District People＇s Hospital, Shenzhen 518000, China)

机构地区：[1]深圳市光明新区人民医院神经外科,广东深圳518000

出　　处：《中华神经外科疾病研究杂志》2017年第4期309-312,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：国家"十二五"科技支撑计划课题基金资助项目(2011BAI08B05)

摘　　要：目的分析应用神经内镜手术治疗基底节区脑出血的疗效,总结内镜血肿清除术的技术细节。方法回顾性分析2015年6月至2016年1月应用神经内镜治疗49例基底节区脑出血患者的临床资料,总结皮质造瘘位置选择、工作通道的走向、预防出血及内镜直视下止血方法等相关技术细节。结果 49例患者手术平均出血量(101.03±21.30)m L、手术时间(62.12±9.29)min、切口长度(5.02±0.37)cm及骨窗面积(6.65±0.31)cm2。术后24 h内行CT扫描,49例患者中43例血肿清除完全,5例血肿少量残留,1例未复查CT,无术后再出血发生。术后1例因脑疝死于脑干功能衰竭,1例死于肺部感染,1例死于消化道出血。存活46例患者均随访6个月以上,日常生活能力量表(ADL)为I级19例,Ⅱ级17例,Ⅲ级5例,IV级5例。结论 (1)神经内镜治疗脑出血具有微创、血肿清除满意及预后良好的特点。(2)恰当的皮质造瘘位置、顺血肿长轴工作通道的走向和术中轻柔的操作,能够最大限度降低手术副损伤;术前及术中实施预防出血的措施有助于减少术中出血机会,内镜下"内镜结合吸引器"等直视下止血方法简便实用,值得推广普及。Objective The clinical effect and technical details of endoscopic surgery in basal ganglia hemorrhage were discussed and sunmmrized. Methods The clinical data of 49 cases of cerebral hemorrhage in basal ganglia from June 2015 to January 2016 were analyzed retrospectively and the technical details including selection of fistulization location, the direction of working channels, the bleeding prevention, and the hemostatic ways under endoscopy. P, amults The mean blood loss was （ 101. 03 ±21.30） mL, the mean operation time was （ 62. 12 ±9. 29） min, the skin incision was （5.02 ±0.37） cm, and the bone window size was （6.65 ±0.31 ） cm^2. Post-operative CT scan within 24 h was performed in 49 cases, which confirmed that the hematomas were evacuated totally in 43 cases, a small amount of residual in 5 cases, and 1 case failed to recheck CT. There were 46 survival cases and 3 death cases, in which 1 case died of brainstem fimction faihtre, 1 of pulmonary infection, and 1 of gastrointestinal bleeding. All these 46 survival cases were followed up for more than 6 months. According to the activity of daily living, there were 19 cases of Grade Ⅰ, 17 cases of Grade Ⅱ, 5 cases of Grade Ⅲ and 5 cases of Grade Ⅳ. Collusion Endoscopic treatment is a minimally invasive, safe and effective method for basal ganglia hemorrhage. The appropriate fistulization place, working channels along the direction of hematoma long axis and careful operation could completely remove the hematoma and reduce the surgical injury to the maximum. Pre-operative and intra-operative bleeding prevention can reduce the hemorrhage during operation. The method of aspirator combined with endoscope is simple and practical, so it is worthy of popularization in clinical practices.

关 键 词：基底节区脑出血 神经内镜 技术细节 

分 类 号：R651.1[医药卫生—外科学]