立体定向微创术治疗脑出血的临床应用

Clinical practice in curing cerebral haemorrhage with stereotactic minimally invasive techynique

目的探讨立体定向技术与微创颅内血肿清除术相结合,提高脑出血治疗的临床疗效。方法在CT引导下,采用简易脑立体定位尺,确定头颅穿刺点后,应用YL-1型颅内血肿粉碎穿刺针和生化酶技术,对颅内血肿进行冲洗、液化,引流清除血肿治疗脑出血82例,并与保守组、手术组各60例比较。术后复查CT观察穿刺方向误差、血肿清除量。结果3组治疗前后神经功能缺损评分比较有显著性差异(F=4.78-5.5,P<0.01-0.05)。微创组治疗后第7、14、2l天,神经功能缺损评分与手术组和保守组比较明显减少,有显著性差异(P<0.05)。保守组与手术组比较,无显著性差异(P>0.05)。微创组总有效率87.25%,与手术组51%和保守组43%比较有显著性差异。微创组病死率8.82%,与手术组23.33%和保守组30%比较有显著性差异。60%的患者首次抽吸血肿量达50%-90%,80%的患者3-7天血肿清除量达90%以上,其余均在2周内吸收。结论立体定向微创术,定位穿刺准确,提高了微创术的成功率,加快了血肿清除速度及神经功能的恢复,降低了病死率,降低了医疗费用,便于各级医院推广应用。

Objective Probe into the combined treatment of stereotactic and minimally invasion in eliminating the encranial haematoma to raise curative effect. Methods Having fixed the puncture position with an encephalometer aided by CT, we did the encephalopuncture with YL-1 puncture needle and the enzyme technique to rinse, liquefy, drainage and eliminate hacmatoma in curing 82 cerebral haemorrhage cases. which are reexamined afterwards by CT, These 82 cases are compared with 60 cases of conservative treatment and 60 cases of operation method of the puncture error and the removed amount of the haematoma. Results There＇s notable difference between the three groups with the nerve functional disorder before or after each treatment（F = 4.78 - 5.5, P 〈 0.01 -0.05） On the 7th, 14th and 21st day after the encephalopuncture, the functional disorder has been strikingly reduced（ P 〈 0.05） with an efficiency of 87.25 % and death rate at 8.82 % to compate with the other tow groups.There＇s no notable difference between the conservative group whose efficiency is 43% while its death rate is 30% and the operation group（ P 〉 0.05） whose efficiency is 51% while its death rate is 23.33 %. Of 60 % patients, the drawing amount of haematoma at the first time reaches 50 % - 90 %, and of 80 % patients the eliminating amount of haematoma reaches 90 % from 3 - 7 day＇ s, and then the remaining haematoma is absorbed within two weeks. Conclusion Stereotactic minimally invasive technique had higher successful rate with more exact puncture, which speed up clearing away the haematoma while recovering nerve function, and reducing death rate as well. Above all, it costs less and is worth spreading in hospitals.