立体定向血肿清除术治疗壳核出血的临床研究

Clinical study on the stereotactic evacuation therapy of putaminal hemorrhage

目的对照分析立体定向血肿清除术和微创血肿穿刺术治疗壳核出血的疗效。方法选择出血量16.0～107.9 ml的壳核出血患者39例,分为立体定向组(20例)和微创组(19例)。立体定向组行立体定向血肿清除术,微创组行常规微创血肿穿刺术。2组患者手术12 h后反复给予尿激酶1万～2万U注入血肿腔内,保留2～4 h后冲洗引流以彻底清除血肿。并分别评定2组患者治疗前及治疗后14、30 d的美国卫生研究院卒中量表(NIHSS)评分和治疗后30 d的扩展格拉斯哥预后评分(GOS-E)。结果立体定向组患者治疗后14、30 d的NIHSS评分明显低于微创组,治疗后30 d的GOS-E评分明显高于微创组(P<0.01)。结论立体定向血肿清除术治疗壳核出血的疗效明显优于微创血肿穿刺术,有利于患者神经功能的恢复。

Objective To compare the efficacy of the stereotactic evacuation therapy and the minimally invasive puncture drainage therapy in treatment of the putaminal hemorrhage. Methods Thirty-nine patients with putaminal hemorrhage, which formed hematoma with volume between 16.0 to 107.9 ml,were divided into two groups：the stereotactic evacuation therapy group（Group Ⅰ , n = 20） and the minimally invasive therapy group（Group Ⅱ, n = 19）. The patients in Group I received stereotactic evacuation therapy and the patients in Group Ⅱ received the minimally invasive puncture drainage therapy. Urokinase of 10 to 20 kU was administered into the hematoma repeatedly 12 hours after the operation and retained for 2 to 4 hours before eliminating the hematoma completely. Allopathy was given to each patient. Neurologic impairment degree scores were assessed using NIHSS on the day before treatment and 14 and 30 days after treatment. The scores of Glasgow Outcome Scale-E（GOS-E） were assessed 30 days after treatment for comparing the outcome between the two groups. Results The NIHSS scores in Group I 14 days and 30 days after treatment were significantly lower than those of Group Ⅱ. The GOS-E scores in Group Ⅰ 30 days after treatment were significantly higher than those of Group Ⅱ （P 〈 0.01）. Conclusions The therapeutic effectiveness of the stereotactic evacuation therapy is much better than that of the minimally invasive puncture drainage therapy.