方体定向软通道微创、液化引流术治疗高血压性壳核出血64例临床分析

Analysis on Cuboid Stereotactic Soft Channel Mini-traumatic, Liquefied Drainage Operation in the Treatment 64 Cases of Hypertensive Putamen Hemorrhage

目的：探讨应用方体定向软通道微创治疗高血压壳核出血的临床疗效及意义。方法：对64例高血压壳核出血患者，由CT引导下依据血肿大小、形态及患者病情，选择适宜的穿刺点及穿刺方向，行方体定向单靶点或多靶点微创软管血肿引流、液化清除术。结果：术中血肿清除率和术后残血清除留管时间：单靶点径路（32.2±18.6）%和（6.5±2.1）d，多靶点径路为（56.5±23.3）%和（4.5±1.5）d，两方法比较差异均有统计学意义。64例患者出院54例，死亡10例，病死率为15.6%。对存活54例患者随访6个月～2年，以日常生活能力（ADL）评估患者神经功能，ADL118例（33.3%）、ADL221例（38.8%）、ADL38例（14.8%）、ADL45例（9.2%）、ADL52例（3.7%）。结论：方体定向软通道微创、液化引流术治疗高血压壳核出血可多轨道、多靶点穿刺，操作简便，创伤微小，最大限度地清除血肿，缩短留置管时间；降低病死率，改善远期预后。

Objective：To investigate the clinical effect and significance of minimally invasive treatment of hypertensive putamen hemorrhage by using cuboid stereotactic soft channel.Method：According to the illness,morphology and size of hematoma by CT guided,64 cases of hypertensive putamen hemorrhage were choosen appropriate puncture point and the direction of puncture to conduct cuboid stereotactic single target or multi-target hematoma minimally invasive hose,liquefaction dissection drainage.Result：Hematoma clearance rate during operation and postoperative residual blood clearance indwelling time：single target path（32.2±18.6）%and（6.5±2.1）d ,multi target path（56.5±23.3）%and （4.5±1.5）d . Comparison of two methods have significant meaning. 54 cases were discharged from hospital and 10 deaths in 64 patients,the mortality rate was 15.6%. On the survival of 54 patients were followed up for 6 months to 2 years and were assessed neurologic function by using activities of daily living（ADL）：ADL1 18 case（33.3%）,ADL2 21 case（38.8%）, ADL3 8 case（14.8%）,ADL4 5 case（9.2%）,ADL5 2 case（3.7%）.Conclusion：In the treatment of hypertension putamen hemorrhage,Cuboid stereotactic soft channel,liquefied drainage can multi-track,multi-target puncture and easy to operate,minimal trauma,to maximize the removal of the hematoma,shorten indwelling tube time,reduce mortality and improve far term prognosis.