经额立体定向丘脑血肿穿刺治疗中等量丘脑出血破入脑室的疗效研究  

Effect of transfrontal stereotactic puncture drainage in the treatment of moderate thalamic hemorrhage breaking into ventricles

作　　者：杨帆[1] 陈华辉 许志剑 徐虎[1] 虞凯杰 童民锋[1] YANG Fan;CHEN Huahui;XU Zhijian;XU Hu;YU Kaijie;TONG Minfeng(Department of Neurosurgery,Jinhua Municipal Central Hospital,Jinhua 321000,Zhejiang,China)

机构地区：[1]金华市中心医院神经外科,浙江金华321000

出　　处：《中国现代医生》2023年第27期49-53,共5页China Modern Doctor

基　　金：金华市科技局重点项目(2022-3-092)。

摘　　要：目的探讨经额立体定向丘脑血肿穿刺治疗中等量丘脑出血破入脑室的疗效。方法回顾性分析2018年1月至2021年12月在金华市中心医院神经外科行钻孔引流的中等量丘脑出血(15~30ml)破入脑室的73例患者的临床资料,其中51例行经额框架立体定向丘脑血肿穿刺置管引流(丘脑穿刺组),22例仅行侧脑室穿刺置管引流(脑室穿刺组),比较两组患者的临床特征及疗效。结果两组的性别、年龄、高血压和糖尿病比例、抗血小板和抗凝药物服用、入院格拉斯哥昏迷评分(Glasgowcoma scale,GCS)、丘脑血肿量、左/右侧出血、发病至手术时间、再出血率、颅内感染率差异无统计学意义(P≥0.05);脑室穿刺组引流管留置时间和住院时间均长于丘脑穿刺组(P<0.05),丘脑穿刺组出院前、术后1个月、术后2个月、术后3个月的Barthel指数[(65.4±9.7)分、(68.7±9.5)分、(71.2±9.0)分、(73.8±8.1)分]均高于脑室穿刺组[(55.3±10.3)分、(57.5±9.9)分、(60.1±8.2)分、(61.4±9.5)分](P<0.05)。结论经额立体定向丘脑血肿穿刺治疗中等量丘脑出血破入脑室可短期内清除丘脑血肿,缩短引流管留置时间和住院时间,改善患者预后。Objective To investigate the effect of transfrontal stereotactic puncture drainage in the treatment of moderate thalamic hemorrhage breaking into ventricles.Methods From January 2018 to December 2021,the clinical data of 73 patients with moderate thalamic hemorrhage(15-30 ml)breaking into ventricles who underwent puncture drainage in the Department of Neurosurgery,Jinhua Municipal Central Hospital were retrospectively analyzed.Among them,51 patients underwent frame stereotaxic through frontal thalamic hematoma puncture and drainage(thalamic puncture group)and 22 patients underwent lateral ventricle puncture and drainage(ventricle puncture group).The clinical characteristics and efficacy of two groups were compared.Results There were no significant differences in gender,age,the proportion of hypertension and diabetes,antiplatelet and anticoagulant drugs,admission Glasgow coma scale(GCS),thalamic hematoma volume,left/right bleeding,onset to operation time,rebleeding rate and intracranial infection rate between two groups(P≥0.05).The drainage tube indwelling time and hospitalization time in ventricle puncture group were longer than those in thalamic puncture group(P<0.05).The Barthel index before discharge(65.4±9.7),1 month(68.7±9.5),2 months(71.2±9.0)and 3 months after operation(73.8±8.1)in thalamic puncture group were higher than those in ventricle puncture group(55.3±10.3),(57.5±9.9),(60.1±8.2)and(61.4±9.5)(P<0.05).Conclusion Transfrontal stereotactic puncture drainage treatment can remove moderate thalamus hematoma in the short term,shorten the indwelling time of drainage tube and hospitalization time,and improve the prognosis of patients.

关 键 词：立体定向 丘脑 血肿 脑室 治疗效果 

分 类 号：R615[医药卫生—外科学]