内镜经额入路治疗伴脑室铸型的原发性高血压基底节区血肿  

Endoscopic Transfrontal Approach in the Treatment of Primary Hypertensive Basal Ganglia Hematoma With Ventricular Casting

作　　者：张嘉[1] 刘彬[1] 谭石[2] 吴超[1] 于涛[1] 司雨[1] 尹晓亮 于国强 谢京城[1] 杨军 Zhang Jia;Liu Bin;Tan Shi(Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China;不详)

机构地区：[1]北京大学第三医院神经外科,北京100191 [2]北京大学第三医院超声科,北京100191

出　　处：《中国微创外科杂志》2021年第12期1095-1098,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北京大学第三医院重点项目(BYSYZD2019004)。

摘　　要：目的探讨内镜经额入路治疗伴脑室铸型的原发性高血压基底节区血肿的安全性和有效性。方法2019年1月~2020年7月我们采用内镜经额入路手术治疗原发性高血压基底节区血肿破入脑室13例,均伴有脑室铸型,全麻下额部直切口5 cm,铣开直径3 cm小骨瓣,超声引导下经额部小骨窗穿刺,置入直径为1.5 cm套管,经内镜清除基底节区血肿及侧脑室内血肿后,利用脑室内镜探查第三脑室,并在内镜下放置第三脑室引流。结果手术时间120~150 min,(132.3±10.9)min;术中出血20~50 ml,(38.5±9.9)ml。术后24 h复查CT见血肿清除率均达90%。术后3例体温升高(最高38.4℃),经抗生素治疗后好转,未发生顽固性中枢神经系统感染。术后7 d拔除脑室引流。13例随访(7.1±4.5)月,格拉斯哥预后评分5分3例,4分6例,3分4例。结论内镜经额入路手术清除伴脑室铸型的原发性高血压基底节区血肿安全可靠。Objective To investigate the safety and efficacy of the endoscopic transfrontal approach for treating primary hypertensive basal ganglia hematoma with ventricular casting.Methods A total of 13 patients with primary hypertensive basal ganglia hematoma involving the ventricle were enrolled between January 2019 and July 2020.They were surgically treated by using an endoscopic transfrontal approach under general anesthesia.A 5-cm frontal straight scalp incision was performed,and a small bone flap with a 3-cm diameter was temporarily removed.With the guidance of intraoperative ultrasound,a cannula with a 1.5-cm diameter was placed through the small frontal bone window.The hematoma in the basal ganglia and lateral intraventricular was removed,and then the third ventricle was explored by intraventricular endoscopy,and a drainage tube was placed in the third ventricle under endoscopy.Results The operation time was 120-150 min[mean,(132.3±10.9)min].The intraoperative bleeding volume was 20-50 ml[mean,(38.5±9.9)ml].The computed tomography demonstrated that the clearance rate of hematoma was 90%at 24 hours postoperatively.The temperature increased in 3 cases(up to 38.4℃),which was relieved following antibiotic treatment.There was no intractable central nervous system infection.The ventricular drainage was removed 7 days after the operation.After an average follow-up period of(7.1±4.5)months,the Glasgow Outcome Scale score was 5 points in 3 cases,4 points in 6 cases,and 3 points in 4 cases.Conclusion The endoscopic transfrontal approach is safe and effective for the treatment of primary hypertensive basal ganglia hematoma with ventricular casting.

关 键 词：原发性高血压 基底节区出血 脑室铸型 内镜 

分 类 号：R65[医药卫生—外科学]