脑出血破入脑室96例手术治疗的临床分析

Clinical Investigation of 96 Cases with Cerebral Hemorrhage Broken into Cerebral Ventricles

目的 探讨脑出血破入脑室的外科手术治疗并辅以术后尿激酶溶解的临床疗效。方法96例脑出血破入脑室患者采用小骨窗开颅联合脑室外引流、单纯脑室外引流以及术后辅以尿激酶溶解．选择性应用腰大池持续引流和腰椎穿刺治疗。结果46例患者采用小骨窗开颅联合脑室外引流治疗，出现术后并发症25例，死亡5例；50例患者采用单纯脑室外引流，出现术后并发症28例，死亡6例。术后3个月随访日常生活能力（ADL）分级：Ⅰ12例；Ⅱ17例；Ⅲ24例；Ⅳ19例；Ⅴ13例；Ⅵ11例。结论脑内血肿超过30ml时，适宜选择小骨窗开颅联合脑室外引流术，而脑内血肿小于30ml时，适于选用单纯脑室外引流术，根据病人情况及出血量来选择手术方式，可以更好的减少术后并发症及降低患者的病残率．提高患者的生存质量。

Objective To evaluate the clinical effectiveness of cerebral hemorrhage broken into cerebral ventricles treatment by invasive surgery with the use of urokinase to thrombolysis. Methods 96 patients with cerebral hemorrhage broken into cerebral ventricles were treated with small bone flap eraniotomy associated ventrieular puncture and external drainage or simple cerebral ventrieular puncture associated external drainage. After operation patients often used urokinase to thrombolysis and selected lumbar puncture or lumbar cistern constant external drainage. Results 46 patients accepted small bone flap craniotomy assoeiated ventricalar puncture and external drainage. 25 cases had postoperative complications and 5 eases died. 50 patients accepted simple cerebral ventricular puncture associated external drainage. 28 eases had postoperative complications and 6 cases died. After operation 3 months, the patients were evaluated by ADL classification： Ⅰ grade was 12 cases; Ⅱ grade was 17 cases; Ⅲ grade was 24 cases; Ⅳgrade was 19 cases; Ⅴgrade was 13 cases; Ⅵ grade was 11 cases. Conclusions The volume of cerebral hemorrhage exceed 30ml, the patients are suitable to choose the simple cerebral ventricular puncture associated external drainage. The volume of cerebral hemorrhage no more than 30ml, the patients are suitable to choose the simple cerebral ventricolar puncture associated external drainage. We should choose the suitable surgery methods according to the patient＇s condition and the volume of cerebral hemorrhage, which can improve the life quality of patients and reduce the postoperative mortality and disability rate.