CT增强扫描及CTA在脑出血早期微创治疗中的应用

The application of CT contrast enhancement(CTE) and CT angiography(CTA) in CT-guiding mini-traumatic treatment of early-stage intracerebral hemorrhage(ICH)

目的探讨CT增强扫描(CTE)及CT血管造影(CTA)在脑出血微创治疗中的价值。方法86例脑出血经CTE或/和CTA检查后,在CT引导下选择避开较大的血管处直接定位,后行颅骨钻孔引流术,并进行定期CT随访观察;6例因发现严重动静脉畸形(AVM)或动脉瘤(AN)出血而放弃微创治疗,行开颅手术或保守治疗。结果86例颅骨钻孔定位准确,引流量20～90ml,占血肿量的40～70%,其中3例因钻孔引流术后血肿扩大而行开颅手术。5例术后住院期间死亡(病死率5.8%);81例术后3月内CT随访复查,血肿消失或大部分消失,最后遗留脑软化灶。术后6月随访生存良好者71例(良好率87.7%)。结论CTE和CTA有助于脑内血肿微创治疗病例的选择和定位,是一种安全可靠、有实用价值的方法。

Objective To investigate the value of CTE and CTA in CT-guiding mini-traumatic treatment on ICH. Methods 86 ICH patients were examined by CTE or/and CTA. After directly located by avoiding the larger blood vessels, they were treated by encephalotomy and followed-up regularly by CT. 6 patients were given-up because of serious AVM or AN bleeding, Instead of them, they were operated on encephalotomy or treated conservatively. Results 86 drilling were located accurately and drainaged 20～90ml, which were 40～70% of the hematoma. 3 patients were operated on encephalotomy because of the expanding hematoma; and 5 patients died in hospital （ the death rate was 5.8%）. After 3 months followed-up by CT, 81 patients hemotoma disappeared or almosfly disappeared and encephalomalacia were left over finally. After 6 months followed-up, 71 patients had well results（ the rate was 87.7%）. Conclusion CTE and CTA are helpful of the selection and location in the mini-traumatic treatment on ICH patients and they are safe and valuable methods.