内镜辅助经胼胝体入路显微手术治疗重度丘脑出血伴脑室铸型  

Analysis of endoscope-assisted transcallosal microsurgery for severe thalamic hemorrhage

作　　者：周林强[1] 王晓军[1] 路阳[1] 于涛[1] 石磊[1] 任峰[1] 曹海波[1] 卞杰勇[1] 

机构地区：[1]苏州市相城人民医院神经外科,215000

出　　处：《中华神经创伤外科电子杂志》2017年第5期264-267,共4页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

基　　金：苏州市科技发展基金资助(SS201608)

摘　　要：目的探讨内镜辅助下经胼胝体入路显微手术治疗重度丘脑岀血伴脑室铸型的临床效果。方法回顾性分析苏州市相城人民医院神经外科自2012年1月至2016年6月内镜辅助下经胼胝体入路显微手术治疗22例丘脑岀血伴脑室铸型患者的临床资料。均经内镜辅助经胼胝体入路行血肿清除,入院时GCS评分9~13分1例,7~8分7例,5~6分10例,4~5分4例。临床均表现为突发意识障碍,一侧肢体不全性偏瘫或/和感觉障碍,部分患者伴有恶心呕吐,入院时有6例出现一侧或双侧瞳孔扩大等脑疝症状,无其他严重的并发症,从发病到手术时间均在为6~24 h。结果 22例患者均无术后颅内感染及再出血,其中消化道出血患者4例、术后继发脑积水行脑室-腹腔引流术患者3例、肺部感染患者7例经处理后均痊愈,术后缄默患者3例于术后3个月基本恢复。术后随访6个月,日常生活活动能力评分:Ⅰ级2例,Ⅱ级4例,Ⅲ级5例,Ⅳ级7例,Ⅴ级4例,预后良好率50%。结论重度丘脑出血采取内镜辅助经纵裂胼胝体入路清除血肿是一种有效的方法,对于改善患者预后,降低患者的病残率有较好的临床价值。Objective Explore the application of endoscope-assisted transcallosal microsurgery technique in the treatment of severe thalamic ventricular hemorrhage.Methods The clinical data of 22 patients with severe thalamic ventricular hemorrhage who were treated by endoscope-assisted transcallosal microsurgery were collected,the operation result and prognosis were analyzed.Endoscopic assisted by the corpus callosum into the line of hematoma removal,admission GCS score 9-13 points in 1 case,7-8 points in 7 cases,5-6 points in 10 cases,4-5 points in 4 cases.Clinical manifestations of sudden disturbance of consciousness,side of the limb incomplete hemiplegia or/and sensory disturbances,some patients with nausea and vomiting,admission,there are 6 cases of side or bilateral pupil enlargement and other hernia symptoms,no other serious Complications,from onset to surgery time are in the 6-24 h.Results Twenty-two patients with postoperative head CT suggest that hematoma are basically all cleared.No postoperative intracranial infection and rebleeding.The patients were followed up for 6 months.There were2 cases of ADL grade Ⅰ,4 cases of ADL grade Ⅱ,5 cases of ADL grade Ⅲ,7 cases of ADL grade Ⅳ,4 case of ADL grade Ⅴ,good recovery rate was 50%.Conclusion Severe thalamic hemorrhage with endoscopic assisted by the corpus callosum approach to remove hematoma is an effective method,and cause low postoperative complications.Further clinical study is needed.

关 键 词：内镜 胼胝体入路 丘脑岀血 显微手术 

分 类 号：R651.1[医药卫生—外科学]