立体定向手术治疗桥脑出血10例

Stereotactic surgery for cerebellopontine hemorrhage

目的探讨立体定向手术治疗桥脑出血的手术方法及治疗效果.方法采用国产FY-98Ⅱ型立体定向仪,通过CT定位,计算以桥脑血肿最大横截面的中心为靶点的三维坐标,在定位系统引导下向靶点置管抽吸尿激酶灌洗引流治疗桥脑出血10例.结果10例均获成功,无手术死亡.手术时间50～80 min,平均60 min.术中出血量25～40 ml,平均30 ml.术后因脑干功能衰竭、消化道出血死亡3例.术后住院时间16～30 d,平均21 d.术后存活7例随访3个月～1年,平均8个月,ADL评定Ⅱ级3例,Ⅲ级2例,Ⅳ级1例,V级1例.结论立体定向手术治疗桥脑出血定位准确,安全可靠,疗效满意.

Objective To investigate surgical techniques and curative effects of stereotactic operation in the treatment of cerebellopontine hemorrhage. Methods Ten cases of cerebellopontine hemorrhage were treated by using the model FY-98 Ⅱ stereotactic apparatus. Under the guidance of CT scanning, three-dimension coordinates of the target that was located at the center of the maximum section of the hematoma were calculated. Then a catheter was introduced into the target for aspiration and urokinase irrigation under the guidance of the stereotactic system. Results The operation was successfully completed in all the 10 cases. The operation time was 50- 80 min （mean, 60 min） and the intraoperative blood loss, 25 -40 ml （mean, 30 ml）. Postoperatively, 3 fatal cases were encountered because of brainstem function failure or upper digestive tract bleeding. The remaining 7 cases survived after operation and were followed for 3 -12 months （mean,8 months）. The postoperative hospital stay was 16- 30 days （mean, 21 days）. Assessment with the Activities of Daily Living （ADL） scale showed grade Ⅱ in 3 cases, grade Ⅲ in 2, Ⅳ in 1, and vegetative state in 1. Conclusions Stereotactic surgery in the treatment of cerebellopontine hemorrhage has advantages of accurate location, high reliability, and satisfactory effect.