CT监视立体定向抽吸术治疗850例脑内血肿临床分析

Clinical report of 850 cases stereotactic aspiration for intracerebral hematomas under CT-monitor

目的 :总结 CT监视立体定向抽吸术治疗脑内血肿时间、方法及结果 ,进一步提高疗效 ,降低致残率和病死率。方法 :通过 CT监视立体定向血肿抽吸术治疗脑出血 85 0例 ,包括皮质下血肿 15 6例 ,基底节血肿5 63例 ,丘脑血肿 86例 ,脑干血肿 4 0例 ,小脑血肿 5例 ;血肿大小 :<3 0 m l 115例 ,3 0～ 60 ml 3 3 6例 ,61～10 0 ml 3 4 3例 ,>10 0 ml 5 6例。抽吸距发病时间 3～ 7小时 5 7例 ,7～ 72小时 4 4 9例 ,72小时～ 7日 3 15例 ,7～14日 2 9例。结果 :存活 685例 ,死亡 165例 ,病死率 19.4 % ;不同部位血肿病死率 :脑干血肿 5 7.5 % ,丘脑血肿3 1.4 % ,基底节血肿 19.6% ,皮质下血肿 3 .9% ,小脑血肿无死亡。血肿一次抽吸≥ 85 %者 4 3 2例 ,血肿一次抽吸 5 0 %～ 84 %者 3 0 6例 ,血肿一次抽吸 <5 0 %者 10 8例 ,完全无法抽出 4例。结论 :超早期和早期 CT监视立体定向抽吸术治疗脑内血肿 ,是一种简单、安全和有效的微侵袭治疗方法。

Objective:To determine the operative opportunity,surgical methods and results of CTmonitored stereotactic aspiration for intracerebral hematomas,in order to reduce operative mortality and morbidity and to improve operative results.Methods:A series of 850 cases of intracerebral hematomas were treated by stereotactic aspiration under CTmonitor.Among them,156 cases were located in subcortical region,563 cases in basillar ganglia,86 cases in thalamus,40 cases in brain stem,and 5 cases in cerebella.As to the size,115 cases of hematomas were less than 30 ml,336 cases between 30 and 60 ml,343 cases between 61 and 100 ml,and 56 cases more than 100 ml.The F L Fischer ZD and CJF systems were employed,and CTmonitor stereotactic aspiration was carried out in all patients.As to the operative opportunity,in 57 cases the hematoma was aspired within 37 hours from the onset of hemorrhage,449 cases within 772 hours,315 cases within 37 days,and 29 cases over 7 days.Results:Six hundred and eightyfive patients survived and 165 patients died with 19.4% mortality.In respect to the location of hematomas,the mortality in brain stem hemorrhage was 57.5%,31.4% in thalamus,19.6% in basillar ganglia,3.9% in subcortical region,and 0 in the cerebellum.Through first aspiration,there was over 85% drainage of hematomas in 432 cases,50%84% in 306 cases,less than 50% in 108 cases,and none in four cases.Conclusions:CTmonitor stereotactic aspiration for intracerebral hematomas is a minimal invasive procedure with simplicity,safety and effectiveness.