经小脑延髓裂入路显微手术治疗小脑出血破入脑室的疗效观察  

Observation of the curative effect of microsurgery through cerebellar medullary fissure approach in the treatment of cerebellar hemorrhage into the ventricles of the brain

作　　者：郭清保[1] 谢曼丽[2] 杨彦龙[1] 马涛[1] 李立宏[1] GUO Qing-bao;XIE Man-li;YANG Yan-long;MA Tao;LI Li-hong(Department of Neurosurgery, Tangdu Hospital of the Fourth Military Medical University, Xi'an 710000, China;Department of Occupational Disease, Xi'an Central Hospital, Xi'an 710000, China)

机构地区：[1]第四军医大学唐都医院神经外科,西安710000 [2]西安市中心医院职业病科,西安710000

出　　处：《中国医学前沿杂志（电子版）》2017年第12期130-133,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨经小脑延髓裂入路显微手术治疗小脑出血破入脑室的临床疗效。方法回顾性分析2013年6月至2016年6月于第四军医大学唐都医院确诊为小脑出血破入脑室的94例患者的临床资料及随访资料,并结合文献对疾病特点及诊疗要点进行分析。结果术后复查头颅CT结果显示,79例患者血肿完全清除,15例患者血肿大部分清除。5例患者术后再出血;21例患者因术后并发肺炎,行气管切开;17例患者顺利封管。随访6个月后,经格拉斯哥预后量表(Glasgow outcome scale,GOS)评分显示:64例(68.1%)患者恢复良好,12例(12.8%)患者中度残疾,6例(6.4%)患者重度残疾,4例(4.3%)患者植物生存,8例(8.5%)患者死亡。除植物生存外的82例存活患者术后并发症为恶心、呕吐(66例)、眩晕(17例)、共济失调(11例)、听力下降(14例)、眼球震颤(8例)、饮水呛咳(4例)、上消化道出血(3例)、下肢深静脉血栓形成(2例)、小脑性缄默症(4例),给予对症处理后,大部分并发症痊愈或好转。结论经小脑延髓裂入路显微手术可以有效清除小脑出血所致第四脑室内的血肿,改善脑脊液循环,降低颅内压,减少对脑组织的损伤及脑内重要功能区的干扰,术后并发症少,有利于控制病情。Objective To observe the curative effect of microsurgery through cerebellar medullary fissure approach in the treatment of cerebellar hemorrhage into ventricles of the brain.Method Retrospectively analyzed the clinical data and follow-up data of94patients who were diagnosed as cerebellar hemorrhage into ventricles of the brain from June2013to June2016in Tangdu Hospital of the Fourth Military Medical University.After reviewing the related literatures,the clinical characteristics and the key points of diagnosis and treatment were discussed.Result As shown by CT scanning,hemotomas were totally removed by microsurgery in79cases,and subtotally removed in15cases.Postoperatively,there were5cases of rehaemorrhagia;21case of pneumonia received tracheotomy,and tracheal tubes in17cases were successfully removed at the end of the follow-up.6months after surgery,outcome was determined according to the Glasgow outcome scale(GOS),which showed that64cases(68.1%)achieved good recovery,12cases(12.8%)were moderately disabled,6cases(6.4%)were severely disabled,4cases(4.3%)were vegetatively survived and8cases(8.5%)died.Various complications occurred in82survival cases except patients in vegetative status,included66cases of nausea/vomit,17cases of dizziness,11cases of ataxia,14cases of hearing loss,8cases of nystagmus,4cases of choking,3cases of upper gastrointestinal bleeding,2cases of lower extremity deep venous thrombosis,4cases of cerebellar mutism syndrome.Cure or improvement occurred in most of cases after symptomatic treatment.Conclusion The fourth ventriclehematoma caused by cerebellar hemorrhage can be effectively evacuated by microsurgery through cerebellar medullary fissure approach,and which can improve cerebrospinal fluid circulation,reduce intracranial pressure,prevent brain damage and thereby protect important brainareas with less postoperative complications.

关 键 词：小脑出血 第四脑室 小脑延髓裂 显微手术 

分 类 号：R651.12[医药卫生—外科学]