立体定向经额及枕下入路治疗脑干出血的效果观察  

Observation on the effect of stereotaxic transfrontal and suboccipital approaches in the treatment of brainstem hemorrhage

作　　者：江耿思[1] 方钦锐 黎学谦 王振宁[1] 邓海亮[1] 刘小红[1] Gengsi Jiang;Qinrui Fang;Xueqian Li;Zhenning Wang;Hailiang Deng;Xiaohong Liu(Department of Neurosurgery,the People's Hospital of Dongguan,Dongguan 523059,China)

机构地区：[1]东莞市人民医院神经外科,广东东莞523059

出　　处：《中华神经创伤外科电子杂志》2023年第1期38-42,共5页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

基　　金：广东省东莞市社会科技发展项目(201950715001637)。

摘　　要：目的:探讨立体定向经额及枕下入路治疗脑干出血的血肿排空效果。方法:选取东莞市人民医院神经外科自2019年9月至2022年6月行手术治疗的24例脑干出血患者,根据术式分为经额组(15例)和枕下组(9例)。记录并比较2组患者术中碎吸血肿量、术后血肿残留量、引流后血肿残留量、术中穿刺脑组织深度、术后血肿腔尿激酶冲洗次数、引流管留置时间等指标。结果:经额组术中碎吸血肿量较枕下组少,穿刺脑组织深度明显深于枕下组,差异均有统计学意义(P<0.05);2组患者术后血肿残留量、引流后血肿残留量、术后尿激酶冲洗次数、引流管留置时间比较,差异无统计学意义(P>0.05)。结论:经额入路虽然术中较难碎吸血肿,但置管引流后最终引流效果与经枕下入路基本相同。血肿位置位于脑桥、中脑水平以上者适合选用经额入路,血肿位置位于脑桥后部及破入第四脑室、小脑者适合选用经枕下入路。Objective To investigate the hematoma emptying effect of stereotaxic transfrontal and suboccipital surgical methods in the treatment of brainstem hemorrhage.MethodsTwenty-four patients with brainstem hemorrhage who underwent surgical treatment in Neurosurgery Department of Dongguan People's Hospital from September 2019 to June 2022 were selected and divided into frontal group (15 cases) and suboccipital group (9 cases) according to the operation type. The intraoperative amount of hematoma broken and sucked out residual hematoma after operation, residual hematoma after drainage, depth of brain tissue puncture during operation, number of urokinase washings in hematoma cavity after operation, and retention time of drainage tube were recorded and compared between the two groups.ResultsThe amount of blood-sucking hematoma in the frontal group was less than in the suboccipital group, and the depth of puncture brain tissue was significantly deeper than that in the suboccipital group, the difference was statistically significant (P<0.05);There was no significant difference between the two groups in the residual amount of hematoma after operation, the residual amount of hematoma after drainage, the number of postoperative urokinase washings, and the retention time of drainage tube (P>0.05).ConclusionAlthough the transfrontal group is more difficult to break and suck out the hematoma during operation, the final drainage effect after catheter and drainage is basically the same as that of the suboccipital group. The transfrontal approach is suitable for hematoma located above the level of the pons and midbrain, and the suboccipital approach is suitable for hematoma located in the posterior part of the pons and broken into the fourth ventricle and cerebellum.

关 键 词：脑干出血 穿刺 经额入路 经枕下入路 立体定向 

分 类 号：R651.1[医药卫生—外科学]