微创置管吸引术治疗高血压脑出血

Aspiration of hypertensive intracerebral hematoma by minimal-trauma installed tube

目的 探索一种简便、实用、效果好的微创定向置软管吸引术治疗高血压脑出血的新方法。方法 根据病人术前CT或CT片上提供的颅脑立体定位数据 ,采用我们自行设计的微创定向颅内置管装置等医疗器械 ,治疗了高血压脑出血病人 16 6例 ,包括急诊即时床边救治2 1例。血肿位于壳核 10 9例 ,丘脑 5 1例 ,脑叶 16例 ,小脑 6例 ,脑干和脑室各 2例 ;血肿小于10ml8例 ,11～ 30ml5 3例 ,31～ 5 0ml5 2例 ,5 1～ 10 0ml 47例 ,10 0ml以上 6例。所有病例术中经单或多靶点径路微创软管脑内血肿抽吸和术后残血尿激酶溶凝引流的方式及对血肿破入脑室积血病人配合腰穿置换治疗。结果 血肿腔内置管准确率 10 0 %。术中血肿清除率和术后残血清除留管时间均值 :单靶点径路为 31 1%和 5 3天 ,多靶点径路为 5 5 5 %和 3 7天 ,两方法比较有显著意义。术后一个月内死亡率为 10 2 %。结论 微创定向脑内血肿置软管吸引术治疗高血压脑出血是一种定位准确 ,方法简易 ,适宜抢救 ,创伤微小 ,疗效确切 。

Objective The study was designed to explore a new method of aspiration of hypertensive intracerebral hematoma by mini interventionalty installed soft tube which proved to be simple,practical and effective.Methods According to the stereotactic data of CT or CT-film in preoperative patients,166 cases with hypertensive intracerebral hematoma were treated by the apparatus has maded by ourselves.The location of hematomas:internal capsule in 140;subcortex in 16;cerebellum in 6;brain stem in 2;and intraventricular in 2.The volume of hematoma:less than 10ml in 8;11～30ml in 53;31～50ml in 52;51～100ml in 47;and more than 100ml in 6.All patients were treated by the aspiration of a minimal-trauma soft-tube by a single or more target approaches and the tube was left as drainage in place for further administration of urokinase and aspiration of the residual dissolved hematoma.Lumbar punctures for the replacement fluid with blood were also done with intraventricular hematomas.Results The accuracy of installing tubes into the cavity of hematomas was 100%.31 1% of volume of the hematoma was evacuated during operations and the drainaging time was 5 3 days in a single target approach;55 5% hematoma evacuated and 3 7 days drainage was in the more target approaches in average.The results of two approaches were compared significantly.The mortality was 10 2% in one month.Conclusion The aspiration of hypertensive intracerebral hematoma by minimal-trauma stereotactic installed soft tube in the hematoma is a new technique,which has been proved to be accurate,effective,simple,and with minimal trauma to the patient.