外伤性颅内血肿的微创治疗

Minimally invasive treatment of traumatic intracranial hematoma.

目的 探讨微创手术治疗外伤性脑内血肿的适应证和方法。方法 选择经颅脑CT检查确诊的外伤性急性硬膜外血肿、脑内血肿、开颅术后迟发性脑内血肿惠者86例，以术前颅脑CT片为依据，进行术前规划。确立入颅点、置管方向及深度、引流管颅内段相应部位加开侧孔的数目。在病床边于局部麻醉下以快速颅锥钻孔，置引流管于血肿腔内，持续外引流，并向血肿腔内注射尿激酶。术后CT复查。结果 微创操作均于15～25min完成。5d复查CT血肿明显减少（〉85％）38例，基本或完全消失48例。痊愈59例，轻残13例，中残9例，死亡5例。病死率为5．81％。无颅内感染发生。结论 对某些外伤性脑内血肿采用微创手术治疗是可行的。只要适应证选择得当，操作得法，可获良好效果。

Objective To explore the indication and methods of minimally invasive treatment of traumatic intracranial hematoma. Methods 86 cases of acute traumatic epidural hematoma, intracerbral hematoma, delayed hematoma before craniotomy were examined by craniocerebral CT. Peroperative plan was done carefully according to the CT film. The point of skull punch, the direction and depth of intubation, and the numbers of added holes at side of phase position in the intracranial part of the drainage-tube were determined. Quick sphenotresia was operated at bedside with local anesthetic. The drainge-tubc was put into the hematoma cavity for external drainage. Urokinase was injected into hematoma cavity. Results Minimally invasive treatment was smoothly accomplished in 15-25 minutes. The hematoma were lessened in 38 cases （ 〉85% ） obviously according tothe reexamining CT after five days. Hematoma of 48 cases disappeared basically or completely. 59 cases recovered, 13 were mildly disabled,9 moderately disabled,5 died. The mortality rate was 5.81%. No intracranial infection occurred. Conclusion Minimally invasive treatment is haverable and effective for traumatic intracranial hematoma,as long as the indication is selected properly.