影像引导下前额锁孔入路内镜基底核区血肿清除术:10例技术报告

Image-guided endoscopic evacuation of basal ganglia hemorrhage by frontal keyhole approach:a 10-case technical report

目的探讨微创内镜技术清除基底核区JOL）的方法。方法分析连续10例自发性基底核区出血病人的临床资料，血肿量18。70ml，平均38．7ml；病人GCS评分5～14分，平均9．7分；病人均存在明确神经功能缺损但未发生脑疝。均行影像引导下前额锁孔入路内镜基底核区血肿清除术。，结果手术耗时45—105min，平均67min。残余血肿体积0—6ml，平均0．8m1：血肿清除率76．9％～100％，平均96．8％。住院时间5—50d，中位时间13d。术后GCS评分7～15分，平均14．1分。术后并发肺部感染4例，其中合并消化道出血和深静脉血栓1例；无切口感染和颅内感染，住院期间无死亡病例。术后1个月、3个月、1年平均GOS评分分别是2．9、3．2、3．0分，有2例左侧出血者术后完全恢复运动和语言功能，随访期间死亡3例。结论内镜技术前额锁孔入路处理基底核区血肿，血肿清除彻底，止血可靠，对脑功能区域影响小，术后并发症少，较经侧方人路显微镜下血肿清除手术有优势。

Objective To explore a method for removing spontaneous basal ganglia hematoma using minimally invasive endoscopic technique. Methods Clinical data of 10 patients with spontaneous basal ganglia hemorrhage were analyzed, and the mean hematoma volume was 38.7 ml, ranging from 18 to 70 ml. The average GCS score was 9.7, ranging from 5 to 14 scores. All the patients suffered from neurological deficits, but no brain herniation occurred. The image-guided endoscopic evacuation of basal ganglia hemorrhage was performed via frontal keyhole approach in all the patients. Results The mean operative time was 67 minutes, ranging from 45 to 105 min. The mean residual hematoma volume was 0.8 ml, ranging from 0 to 6 ml, with an average evacuation rate of 96.8 %, ranging from 76.9% to 100%. The median time of hospital stay was ! 3 days, ranged from 5 to 50 days. The mean GCS score was 14.1 scores, ranged from 7 to 15 scores after surgery. Pulmonary infection occurred in 4 patients postoperatively, out of them, one had concomitant gastrointestinal bleeding and lower extremity deep venous thrombosis. No wound infection or intracranial infection occurred. No patient died during hospitalization. The mean GOS score of 1 month, 3 months and 1 year after surgery were 2.9, 3.2 and 3.0 scores respectively. Two patients who had intracerebral hemorrhage on the left side completely restored the movement and language function. Three patients died during the follow-up period. Conclusion Image-guided endoscopic evacuation of hematoma via frontal keyhole approach can exhibit superiors of complete clearance, reliable hemostasis, little influence on brain functional areas, and fewer complications over microscopic hematoma evacuation via lateral approach for basal ganglia hematomas.