YL-1型针微创穿刺引流治疗急性硬膜外血肿的临床分析

Clinical Analysis of Microinvasive Puncture and Drainage for Acute Traumatic Epidural Hematoma with YL-1 Puncture Needle

目的 探讨YL-1型针微创穿刺引流治疗急性硬膜外血肿的临床疗效.方法 急性硬膜外血肿19例,采用CT引导定位,以血肿中心为靶点,YL-1型颅内血肿粉碎穿刺针经头皮穿刺冲洗、粉碎、引流血肿,并联合尿激酶（1×104～2×104 U/次）溶解血肿. 结果本组19例全部治愈,术后持续引流时间平均3.6（3～5）d, 无一例需要输血, 未出现术中大出血或术后血肿复发. 无一例死亡, 亦未发生颅内感染、张力性气颅等并发症.拔针前复查CT证实血肿清除90%～100%,占位效应消失或明显减轻.住院时间平均9.6（6～15）d.出院时日常生活量表（activity of daily living, ADL）分级：Ⅰ级17例,Ⅱ级2例.13例随访3～6月,平均（4.5±1.5）月,GOS分级均为Ⅰ级.结论 YL-1型针微创穿刺引流术治疗急性硬膜外血肿,疗效确切、微创、节省医疗费用,手术时准确选择适应证、把握手术时机非常重要.

Objective To explore curative effects of minimally invasive puncture and drainage for acute traumatic epidural hematoma with YL-1 needle.Methods A total of 19 cases with acute traumatic epidural hematoma were treated by pucture and drainage with YL-1 needle under the guidance of CT scans.In addition,urokinase was administrated to dissolve hematoma.Results The duration of constant drainage was 3 to 5 days with an average of 3.6 days.All the 19 cases cured completely without blood transfusion and hematoma recurrence.No case died and no complications occurred such as intracranial infection and tension pneumocephalus.The CT scan showed 90% to 100% hematoma was eliminated and mass effect was improved obviously or disappeared completely before withdrawal of needles.The hospital stay was 6 to 15 days with an average of 9.6 days.According to the activities of daily living（ADL） classification,there were 17 cases of grade Ⅰ and 2 cases of grade Ⅱ when discharge from hospital.13 cases were followed up for 3 to 6 months with an average of 4.5±1.5 months,and were recovered to grade Ⅰ of Glasgow outcome scale（GOS）.Conclusions Intracerebral puncture and drainage with YL-1 needle is effective,minimally invasive and economic for traumatic acute epidural hematoma.However,the proper indication selection and seizing operative opportunity is important to guarantee success of the procedures.