锁孔手术治疗自发性和部分外伤性脑出血的临床观察  

Clinical observation of keyhole surgery in the treatment of spontaneous and partial traumatic intracerebral hemorrhage

作　　者：郭志旺 郭仰韩 杜文欢 张顺[1] 常会民[1] 林鹏 许宝来 方翠容 GUO Zhi-wang;GUO Yang-han;DU Wen-huan;ZHANG Shun;CHANG Hui-min;LIN Peng;XU Bao-lai;FANG Cui-rong(Department of Neurosurgery,Guangdong Corps Hospital,Chinese People′s Armed Police Force,Guangzhou 510507,Guangdong,China)

机构地区：[1]中国人民武装警察部队广东总队医院神经外科,广东广州510507

出　　处：《广东医学》2025年第1期145-149,共5页Guangdong Medical Journal

摘　　要：目的探讨锁孔手术在自发性脑出血和部分外伤性脑出血患者中的应用。方法回顾性分析武警广东总队医院神经外科经锁孔手术治疗的120例自发性脑出血患者(包括高血压脑出血96例、脑动脉瘤破裂出血15例、脑血管畸形破裂出血患者9例)和40例外伤性脑出血患者的临床资料,进行总结分析,均在发病72 h内手术。结果术后2~24 h内复查CT,首次血肿清除率90%以上者126例(86.8%),15例动脉瘤患者均完全夹闭。术后6个月日常生活能力(ADL)分级,Ⅰ级73例(36.1%),Ⅱ级87例(43.1%),Ⅲ级32例(15.8%),Ⅳ级5例(2.5%),Ⅴ级3例(1.5%)。术后因并发症死亡2例(1.0%)。结论只要病例选择适当,锁孔手术可安全使用于自发性和部分外伤性脑出血患者。Objective To evaluate the application of keyhole surgery in patients with spontaneous intracerebral hemorrhage(ICH)and partial traumatic ICH.Methods A retrospective analysis was conducted on 120 patients with spontaneous ICH,including 96 with hypertensive ICH,15 with aneurysmal rupture hemorrhage,and 9 with arteriovenous malformation rupture hemorrhage,as well as 40 patients with traumatic ICH treated via keyhole surgery.All surgeries were performed within 72 hours of onset.Results Postoperative CT scans conducted within 2-24 hours showed a hematoma clearance rate exceeding 90%in 126 cases(86.8%).Complete clipping was achieved in all 15 aneurysm cases.At 6 months post-surgery,the daily living ability(ADL)grades of the patients were as follows:Grade Ⅰ in 73 cases(36.1%),Grade Ⅱ in 87 cases(43.1%),Grade Ⅲ in 32 cases(15.8%),GradeⅣin 5 cases(2.5%),and GradeⅤin 3 cases(1.5%).Two patients(1.0%)died due to postoperative complications.Conclusion Keyhole surgery is a safe and effective treatment option for selected patients with spontaneous and partial traumatic ICH.

关 键 词：锁孔手术 自发性脑出血 外伤性脑出血 临床观察 

分 类 号：R459.7[医药卫生—急诊医学] R615[医药卫生—治疗学]