激光定位软通道穿刺引流中小量基底节高血压脑出血178例  

Treatment of 178 cases of small and medium-sized hypertensive cerebral hemorrhage in the basal ganglia area using soft channel puncture and drainage under laser positioning

作　　者：张凌云 梅小杰 段继新 唐丹 肖淳文 李春辉 ZHANG Lingyun;MEI Xiaojie;DUAN Jixin;TANG Dan;XIAO Chunwen;LI Chunhui(Department of Neurosurgery,Hunan Aerospace Hospital;Department of Neurosurgery,General Hospital of Hunan Medical College;Department of Neurosurgery,Huaihua Central Hospital;Department of Neurosurgery,First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha,Hunan 410000,China)

机构地区：[1]湖南航天医院神经外科 [2]湖南医药学院总医院神经外科 [3]怀化市中心医院神经外科 [4]湖南中医药大学附属一医院神经外科,湖南长沙410000

出　　处：《中华神经外科疾病研究杂志》2024年第1期67-71,共5页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探讨激光定位软通道穿刺引流治疗伴神经功能障碍的中小量基底节区高血压脑出血患者的效果.方法回顾性分析2020年7月至2023年1月湖南省内多家医院收治的伴神经功能障碍的中小量(15~30 ml)基底节区脑出血患者178例,均采用新型激光定位技术行软通道穿刺引流治疗.记录这178例手术患者术后复查CT及血肿清除情况,以及手术前至外科出院前的神志和肌力改变情况.结果所有病例均精准定位血肿,无死亡及感染病例,术后再出血病例2例,162例患者术后3天内残留血肿<5 ml,13例患者术后3天内残留血肿在5~15 ml范围,3例患者术后3天内残留血肿>15 ml.178例脑出血患者术后意识障碍及肌力大部分明显恢复,其中有61例在术后3天内肌力恢复≥2级.术后3~7天有9例肌力恢复≥2级.结论激光定位软通道穿刺引流是治疗基底节区中小量高血压脑出血的有效手段,创伤小且能有效促进患者神经功能恢复.相当比例患者存在神经功能的早期快速恢复期.Objective To explore the effect of soft channel puncture and drainage under laser positioning in the treatment of small and medium-sized patients with hypertensive cerebral hemorrhage(HICH)in the basal ganglia area accompanied by neurological dysfunction.Method Retrospective analysis of 178 patients with small to medium-volume(15~30 ml)basal ganglia HICH with neurological dysfunction who were admitted to multiple hospitals in Hunan Province from July 2020 to January 2023,all of which used new laser positioning technology to perform soft channel Puncture and drainage treatment.The postoperative CT reexamination and hematoma clearance of these 178 surgical patients were recorded,as well as the changes in consciousness and muscle strength from before surgery to before discharge from surgical unit.Results The hematoma was accurately located in all cases.There were no cases of death or infection.There were 2 cases of re-bleeding after surgery.162 patients had residual hematoma<5 ml,13 patients with residual hematoma 5~15 ml while 3 patients with residual hematoma>15 ml 3 days after surgery.Most of the 178 patients with HICH had significant recovery in consciousness disorder and muscle strength after surgery,and 61 of them had muscle strength recovery of≥2 levels within 3 days after surgery.There were 9 cases of muscle strength recovery with≥grade 2 at 3~7 days after surgery.Conclusion Soft channel puncture and drainage under laser positioning was an effective method for treating small amounts of HICH in the basal ganglia area.It is less invasive and can effectively promote the recovery of patients'neurological function.A significant proportion of patients experience an early and rapid recovery period of neurological function.

关 键 词：激光定位 高血压脑出血 基底节区 中小量血肿 钻孔引流 

分 类 号：R742[医药卫生—神经病学与精神病学]