高血压重症基底节－丘脑区血肿CT分型与手术选择

CT Classification and Surgical Selection of Severe Basal Ganglia-Thalamus Region Hematomas in Hypertensive Patients

目的：利用高血压重症基底节－丘脑区血肿ＣＴ影像；探讨ＣＴ分型与手术适应症、手术方式选择的关系。材料与方法：回顾性分析１１３例高血压重症基底节－丘脑区血肿的ＣＴ分型与手术预后。分型：Ⅰ型（ｎ＝４２），位于内囊外侧，很少破入脑室；Ⅱ型（ｎ＝２４），扩延到内囊，可破入脑室；Ⅲ型（ｎ＝１４），同时扩延到内囊和丘脑或下丘脑，破入脑室；Ⅳ型（ｎ＝２３），以丘脑出血为主，向基底节扩延，总量＜３０ｍｌ，破入脑室；Ⅴ型（ｎ＝１０），扩延到中脑或桥脑，破入脑室。手术预后以患者术后半年日常生活能力评价。结果：手术总死亡率３２．７４％，其中Ⅰ型１４．２９％，Ⅱ型２５％，Ⅲ型７８．５７％，Ⅳ型１７．３９％，Ⅴ型１００％，Ｐ＜０．００１。结论：作者认为Ⅰ、Ⅱ型力争早期手术，早期出现上消化道出血之Ⅲ型慎用手术，Ⅳ型仅作脑室外引流即可，Ⅴ型无手术指征。ＣＴ分型为手术选择提供了可靠依据。

To study the CT classification and the surgical selection of severe basal ganglia-thalamus region hematomas(SBGTH) in hypertensive patients,Materials and Methods:CT manifestations and prognosis of 113 cases hypertensive hematomas in SBGTH were investigated.According to extension of hematomas,there were five types shown on CT scans:typeⅠ(n=42),the mass was located in the external capsule;type Ⅱ(n=24),the internal capsule was invaded;type Ⅲ(n=14),the internal capsule and thalamus or hypothalamas were invaded;type Ⅳ(n=23),thebleeding was mainly located in the thalamus;type Ⅴ(n=10),the hematomas extended to the midbrain or the pon.Postoperative prognosis estimations were made in terms of the activity of daily living after a half year.Results:Total postoperative mortalityofthepatientswas32.74%;type Ⅰ 14.29% Ⅱtype Ⅱ 25%;type Ⅲ 78.57%; type Ⅴ 17.39%;type Ⅴ 100%,respectively,P<0.001.Conclusion:It is believed that the patients with type Ⅰ and Ⅱ should be operated as early as possible.The patients with type Ⅲ were usually complicated with the hemorrhage of the upper digestive tract and should be handled with great care. The ventricles drainage were needed for patients of type Ⅳ.It seems that no operation is indicated for patients of type Ⅴ.CT classification can provide reliable evidence for surgical choice of SBGTH in hypertensive patients.