CTA在脑出血早期微创治疗中的应用

The application of computed tomographic angiography （CTA） in mini- traumatic operation of early-stage intracerebral hemorrhage（ICH）

目的：探讨CT血管造影（CTA）在高血压脑出血脑内血肿微创治疗中的价值.方法：89例脑出血并有高血压病史患者,经CT平扫及CTA检查后,80例脑出血（包括4例烟雾病）患者,在CT及CTA引导下选择避开较大的血管处直接定位,使用YL-1型一次性颅内血肿粉碎穿刺针行微创颅内血肿清除治疗,并进行定期CT 随访观察;9例因发现动静脉畸形（AVM）或动脉瘤（AN）出血而放弃微创治疗,行开颅手术治疗.结果：80例微创治疗患者定位准确,脑内血肿引流量20～80ml,占血肿量的60%～90%,其中4例因微创引流术后血肿扩大而行开颅手术.7例术后住院期间死亡（病死率8.75%）;73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63例（良好率86.3%）.结论：CTA对于高血压脑出血脑内血肿的微创治疗有不可替代的指导作用,有利于脑内血肿患者的救治.是一种安全可靠、快捷无创、价廉有实用价值的方法.

Objective To investigate the value of computed tomograpbicangiography （CTA） in mini- traumatic operation treatment of hypertensive intracerebral hemorrhage （HIH）. Methods 89 ICH patients with hypertensive disease were examined by CT and CTA. After directly located by avoiding the larger blood vessels, The 80 patients＇s intracerebral hemorrhage eliminated by using type YL- 1 intracranial hematoma comminute biopsy puncture needles ,and followed- up survey regularly by CT. Mini- traumatic operation were givenup because of arteriovenous malformation （AVM） or aneurysm （AN） bleeding in 9 patients. Instead of mini--traumatic operation,they were operated. Results Drilling were located accurately and drainaged 20-80ml of 80 patients＇s intracerebral hemorrhage, which were 40-70% of the hematoma, Clearance of intracerebral hematoma were used because of the expanding intracerebral hematoma in 4 patients ;and 7 patients died in hospital （the mortality rate was 8.75 %）. After 3 months followedup by CT, 73 patients＇s hemotoma disappeared or almostly disappeared and eneephalomalacia were remained finally. After 6 months followed- up,63 patients recovered well（the favorable rate was 86.3%）. Conclusion CTA is more helpful of the selection and location in the minitraumatic operation on intracerebral hemorrhage and this is safe and valuable methods.