新型立体定向仪辅助下经额穿刺引流术治疗高血压性基底节区脑出血的临床应用  

New-type stereotaxic apparatus-assisted transfrontal puncture and drainage in treatment of hypertensive intracerebral hemorrhage in the basal ganglia

作　　者：惠培泉[1] 宋磊[1] 王增武[1] 秦时强[1] 王毅[1] 郭晖[1] 曲秉坤[1] 乜全民 Hui Peiquan;Song Lei;Wang Zengwu;Qin Shiqiang;Wang Yi;Guo Hui;Qu Bingkun;Nie Quanmin(Department of Neurosurgery,People's Hospital of Weifang,Weifang 261000,China)

机构地区：[1]潍坊市人民医院神经外科,261000

出　　处：《中华神经医学杂志》2020年第12期1240-1246,共7页Chinese Journal of Neuromedicine

摘　　要：目的探讨一次性新型立体定向仪辅助下经额穿刺引流术治疗高血压性基底节区脑出血的疗效。方法潍坊市人民医院神经外科自2017年8月至2019年9月在一次性新型立体定向仪辅助下经额穿刺引流术治疗高血压性基底节区脑出血患者60例,现回顾性分析这些患者的临床资料和疗效。结果患者均一次穿刺成功,穿刺平面在基底平面上5.0~6.5 cm,穿刺角度为10~14°,穿刺深度为9.0~11.5 cm。出血后6 h以内手术患者15例,术中血肿清除率约为25%;出血后6~24 h手术患者40例,术中血肿清除率约为20%;出血后1~3 d手术患者5例,术中血肿清除率高达30%。术后首次CT复查显示引流管位置理想51例、过深2例、过浅1例、位置偏下2例、位置偏上2例、位置偏内1例、位置偏外1例。术后第3天患者的格拉斯哥昏迷量表(GCS)评分[(9.880±3.998)分]较术前[(6.240±3.159)分]明显增高,差异有统计学意义(P<0.05)。术后1个月格拉斯哥预后量表(GOS)评分显示痊愈良好20例(33.3%)、轻残28例(46.7%)、重残7例(11.7%)、植物生存3例(5.0%)、死亡2例(3.3%)。结论一次性新型立体定向仪设计合理,定位准确,在其辅助下经额穿刺引流术治疗高血压性基底节区脑出血简单易行,手术创伤小,疗效满意。Objective To investigate the efficacy of new-type stereotaxic apparatus-assisted transfrontal puncture and drainage in the treatment of hypertensive intracerebral hemorrhage in the basal ganglia.Methods A retrospective analysis was performed on the clinical data of 60 patients with hypertensive intracerebral hemorrhage in the basal ganglia who received disposable new-type stereotaxic apparatus-assisted transfrontal insertion with soft tunnels for hematoma aspiration drainage in our hospital from August 2017 to September 2019.The treatment efficacy was analyzed.Results All patients were successfully punctured at one time;the puncture surface was 5-6.5 cm on the basement plane,where the hematoma surface was the largest;the puncture angle was 10-14°,and the puncture depth was 9-11.5 cm.Fifteen patients were operated within 6 h of hemorrhage,and the intraoperative hematoma clearance rate was about 25%;40 patients were operated 6-24 h after hemorrhage,and the hematoma clearance rate was about 20%;5 patients were operated one-3 d after hemorrhage,and the hematoma clearance rate was as high as 30%.The first postoperative re-check CT showed that 51 patients had ideal position of the drainage tube,2 were too deep,one was too shallow,2 were below the position,2 were above the position,one was inside the position,and one was outside the position.The Glasgow Coma Scale(GOS)scores of the patients on 3rd d of operation(9.88±3.998)were significantly higher than those of the patients before operation(6.24±3.159,P<0.05).One month after the operation,GOS showed that 20 patients(33.3%)had good recovery,28(46.7%)had mild disability,7(11.7%)had severe disability,3(5.0%)had plant survival,and 2(3.3%)died.Conclusion The disposable new-type stereotaxic apparatus-assisted transfrontal puncture drainage is easy to be conducted and practicable with a reasonable design,accurate positioning,minimal surgical traumas and satisfactory curative effect.

关 键 词：高血压性基底节区脑出血 一次性新型立体定向仪 经额穿刺引流术 

分 类 号：R651.1[医药卫生—外科学]