侧脑室额角造瘘经脉络裂入路清除丘脑出血(附21例报告)  

Surgical evacuation of thalamic hemorrhage through transchoroidal fissure approach:a preliminary report of 21 cases

作　　者：陈明武[1] 郑诗豪[1] 王开宇[1] Chen Mingwu;Zheng Shihao;Wang Kaiyu(Department of Neurosurgery,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院神经外科,福州350001

出　　处：《创伤与急诊电子杂志》2022年第4期207-212,共6页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨侧脑室额角造瘘经脉络裂入路在丘脑出血手术治疗中的应用。方法选取福建省立医院2017年1月到2021年1月期间应用侧脑室额角造瘘经脉络裂入路清除丘脑出血的21例患者,回顾性分析患者的临床资料及随访结果,评估手术的安全性及有效性。结果术前患者丘脑出血血肿量平均(28.95±5.10)ml。血肿分型中,后外侧型12例(57.14%),内侧型5例(23.81%),前外侧型4例(19.05%),无背侧型患者。术后8~24h内患者均复查颅脑CT,提示血肿清除80%~97%,平均(85.90±4.23)%,无术后再出血,围术期死亡2例(9.52%),其中1例患者术后出现颅内感染。19例患者获得随访,术后6个月改良Rankin量表(modified Rankin scale,mRS)评分1~2分5例(26.32%),3~4分6例(31.58%),5分7例(36.84%),6分1例(5.26%)。结论侧脑室额角造瘘经脉络裂入路清除丘脑出血手术开关颅简单快速、解剖定位清晰、血肿清除微创且确切。血肿量超过20ml的后外侧型丘脑出血及部分前外侧型、内侧型丘脑出血可能是此手术入路的适应证。Objective To evaluate the effect and safety of surgical evacuation of thalamic hemorrhage through transchoroidal fissure approach.Method We retrospectively analyzed the clinical data and follow-up results of 21 patients with thalamic hemorrhage who underwent surgical evacuation through transchoroidal fissure approach from January 2017 to January 2021.The volume of thalamic hemorrhage before and after surgery,the types of thalamic hemorrhage,the postoperative complications and mortality,and the modified Rankin Scale(mRS)score at 6 months were recorded.Result The mean volume of thalamic hemorrhage before surgery was(28.95±5.10)ml.There were 12(57.14%)patients with posterolateral type,5(23.81%)patients with medial type,4(19.05%)patients with anterolateral type and none with dorsal type of thalamic hemorrhage.The mean percentage of hematoma evacuation was(85.90±4.23)%.One patient developed postoperative intracranial infection and no patient had postoperative rebleeding.The perioperative mortality rate was 9.52%.Among the 19 patients who were followed up for 6 months,5(26.32%)had an mRS score of 1-2 points,indicating good recovery;6(31.58%)had an mRS score of 3-4 points,indicating moderate disability;and 8(42.11%)had an mRS score of≥5 points,indicating severe disability or death.Conclusion Surgical evacuation of thalamic hemorrhage through transchoroidal fissure approach is a simple,fast and effective procedure that can achieve satisfactory hematoma removal with minimal damage to surrounding structures.More than 20ml of posterolateral type,and parts of anterolateral and medial type of thalamic hemorrhage may be suitable candidates for this surgical approach.

关 键 词：丘脑出血 侧脑室额角造瘘经脉络裂入路 治疗效果 

分 类 号：R651.1[医药卫生—外科学]