颅内血肿微创穿刺清除技术治疗基底节区脑出血

Intracranial Hematoma Microinvasive Craniopunture Scavenging Technique for Ganglionic Hemorrhage

目的介绍一种经过改良的血肿抽吸和引流方法治疗基底节区脑出血——颅内血肿微创穿刺清除技术。方法在CT辅助下对颅内血肿进行人工定位后,将直径3 mm的导管插入血肿,谨慎抽吸,之后反复复查CT并注入尿激酶引流,直至引流管尖端周围血肿消失。记录患者的临床特征,比较术前和拔管前的血肿体积、中线位移,格拉斯哥昏迷量表(GCS)评分。结果接受该方法治疗的16例患者拔管前血肿体积明显小于术前血肿(P<0.01),血肿清除率平均为87%;术前和拔管前中线位移的平均长度分别为(10.96±2.78)、(3.30±1.85)mm,拔管前中线位移明显小于术前(P<0.01);拔管前患者GCS评分平均为(14.25±1.00),较术前(8.25±2.24)增加了6分(P<0.01)。术后6个月随访,14例患者(87.5%)神经功能恢复良好,2例患者(12.5%)遗留严重残疾。结论颅内血肿微创穿刺清除技术是大面积基底节区脑出血切实可行的、安全的微创治疗方法。

Objective To introduce the initial experience using a modified approach,the intracranial hematoma（ICH）microinvasive craniopunture scavenging technique（MPST）,of aspiration and lysis in patients with spontaneous ganglionic hemorrhage.Methods After manual localization of the hematomas with the assistance of CT,the 3-mm diameter catheter was inserted into the hematoma followed by cautious aspirations.Then,a protocol of CT scan and urokinase instillation was repeated as necessary until the final hematoma volume was 〈1/3 or the clot around the tip of the catheter seemed nearly invisible on the CT scan.The clinical data of the treated patients were recorded,and the differences between the initial and final hematoma volume,initial and final midline shift,initial and final Glasgow coma scale（GCS）score were compared respectively.Results Sixteen patients with ICH were treated with this procedure.The average final hematoma volume was significantly less than the initial hematoma volume（P〈0.01多）.The mean final midline shift was significantly reduced as compared with the initial midline shift（P〈0.01）.The mean final GCS score was significantly higher than the initial GCS score.During a follow-up period of 6 months,14 patients（87.5%）achieved satisfactory recovery,and 2 patients（12.5%）were severely disabled.Conclusion Without special stereotactic instruments,the intracranial hematoma MPST is a feasible and safe minimally invasive surgical approach for extensive ganglionic ICH.