术中超声联合内镜技术治疗自发性脑内血肿经验初探  

Preliminary exploration of intraoperative ultrasound⁃guided endoscopic evacuation of spontaneous intracerebral hematoma

作　　者：张家墅[1] 陈晓雷[1] 王群[1] 徐兴华[1] 吴东东[1] 孙正辉[2] 吕发勤[3] 张军[1] 余新光[1] 许百男[1] ZHANG Jia-shu;CHEN Xiao-lei;WANG Qun;XU Xing-hua;WU Dong-dong;SUN Zheng-hui;LÜFa-qin;ZHANG Jun;YU Xin-guang;XU Bai-nan(Department of Neurosurgery,the First Medical Center of PLA General Hospital,Beijing 100853,China;Department of Neurosurgery,Hainan Hospital of PLA General Hospital,Sanya 572013,Hainan,China;Department of Ultrasonography,Hainan Hospital of PLA General Hospital,Sanya 572013,Hainan,China)

机构地区：[1]解放军总医院第一医学中心神经外科,北京100853 [2]解放军总医院海南医院神经外科,三亚572013 [3]解放军总医院海南医院超声科,三亚572013

出　　处：《中国现代神经疾病杂志》2021年第3期212-217,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家自然科学基金资助项目(项目编号:81371561);解放军总医院科技创新苗圃基金资助项目(项目编号:15KMM19);解放军总医院临床科研扶持基金资助项目(项目编号:2016FC⁃TSYS⁃1023)。

摘　　要：目的评价采用术中超声联合内镜技术治疗自发性脑内血肿的临床应用价值。方法2016年10月至2019年10月解放军总医院第一医学中心和海南医院神经外科共对17例自发性脑出血患者实施超声引导内镜下脑内血肿清除术,术中采用超声诊断仪定位血肿位置、反馈血肿清除程度;术后计算血肿清除率并记录超声和内镜相关并发症或不良事件,采用Karnofsky功能状态评分(KPS)评价神经功能改善程度。结果17例患者手术成功率达100%,且无一例发生与超声或内镜相关并发症或不良事件;所有患者均在超声引导下将内镜工作通道一次性准确置入血肿中心。17例患者术前血肿量中位值为44.40(31.20,54.35)ml、术后3.00(1.80,5.10)ml,血肿清除率约94.01%(87.11,96.08)%;术前KPS评分中位评分为20(15,30)、术后2周中位评分为40(35,50),较术前明显改善(Z=⁃3.671,P=0.000)。结论术中超声联合内镜技术治疗自发性脑内血肿安全、可行,该项联合技术有助于准确定位血肿、提高血肿清除率、减少并发症和促进神经功能恢复。Objective To investigate the clinical value of intraoperative ultrasound and endoscopy technique on the surgery of spontaneous intracerebral hematoma.Methods A total of 17 patients who underwent ultrasound⁃guided endoscopic evacuation of spontaneous intracerebral hematoma from October 2016 to October 2019 in Department of Neurosurgery of the First Medical Center of PLA General Hospital and Hainan Hospital were selected.All hematomas were located by ultrasound during operation.At the same time,feedback the degree of hematoma clearance and calculate the hematoma removal rate.Record ultrasound and endoscopy⁃related complications or adverse events.Use Karnofsky Performance Status(KPS)to evaluate postoperative neurological function improvement.Results Intraoperative ultrasound and endoscopic technique were conducted in all 17 patients with a success rate of 100%,and no ultrasound and endoscopic⁃related complications or adverse events occurred.In all cases,endoscopic working sheath was once accurately introduced into the center of hematoma.Preoperative median volume of hematoma was 44.40(31.20,54.35)ml,and postoperative median volume was 3.00(1.80,5.10)ml,and the extent of hematoma removal rate was 94.01%(87.11,96.08)%.Preoperative median KPS score was 20(15,30),and median KPS score was 40(35,50)2 weeks after operation,which was significantly improved(Z=⁃3.671,P=0.000).Conclusions These results suggest that intraoperative ultrasound⁃guided endoscopic surgery is a safe and feasible surgical modality for spontaneous intracerebral hematoma.This combined technique may help to localize the hematoma more accurately,enhance the extent of hematoma removal,and reduce complications and facilitate neurological recovery.

关 键 词：脑出血 血肿 超声检查 内窥镜检查 神经外科手术 

分 类 号：R651.1[医药卫生—外科学]