经额软通道微创穿刺引流术治疗高血压性基底节区脑出血76例临床分析

Minimally invasive transfrontal puncture drainage for hypertensive basal ganglia hemorrhage using soft drainage tubes： 76 cases reported

目的探讨经额软通道微创穿刺引流术治疗高血压性基底节区脑出血的技术方法和临床疗效。方法对山东省邹城市红十字会急救中心神经外科自2005年3月至2008年4月收治且符合条件的76例高血压性基底节区脑出血患者，选择血肿侧距眉间7-9cm、旁开中线3．5-4．5cm的额部为穿刺点，根据头颅CT影像资料计算确定适宜的穿刺方向和穿刺深度，以软通道行血肿腔的微创穿刺引流术清除脑内血肿。结果术后引流管留置时间36～120h，平均（70±5．6）h。术后再出血3例，均无气颅或颅内感染发生。76例患者中30d内基本痊愈11例，显著进步35例，进步16例，无效或恶化4例，死亡10例，病死率为13．2％，总有效率为81．6％。结论经额软通道微创穿刺引流术治疗高血压性基底节区脑出血是一种切实有效的治疗方法，能最大限度的减少术后并发症发生，从而改善患者预后，且创伤小、操作简单，易于在基层医院推广应用。

Objective To evaluate the techniques and clinical effect of minimally invasive transfrontal puncture drainage using soft drainage tubes in the treatment of hypertensive basal ganglia hemorrhage. Methods Seventy-six patients with hypertensive basal ganglia hematomas received minimally invasive puncture drainage of the hematomas using soft drainage tubes. The puncture site was located in the frontal region on the hemorrhage side at 7-9 cm from the glabella and 3.5-4.5 cm adjacent to the midline. The puncture direction and depth was estimated according to the head CT data. Results The indwelling time of the drainage tubes ranged from 36 to 120 h （mean 70±5.6 h） after the operation. Three patients （3.95%） had recurrent hemorrhage after the operation, but intracranial infection or pneumocephalus occurred in none of the cases. Of the 76 patients, 11 had basic clinical cures, 35 showed marked improvements, and 16 showed improvements, with a total effective rate of 81.6%. Four patients failed to show improvements or had exacerbations, and 10 died after the operation, with a mortality rate of 13.2%. Conclusion Minimally invasive transfrontal puncture drainage using soft drainage tubes is effective for treatment of hypertensive basal ganglia hematomas. With simple surgical procedures, this approach can effectively reduce the occurrence of complications and improve the prognosis of the patients.